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Saba L, Cau R, Kopczak A, Schindler A, Saam T. Reply: Carotid Plaque-RADS: A Novel Stroke Risk Classification System. JACC Cardiovasc Imaging 2024; 17:227. [PMID: 38325961 DOI: 10.1016/j.jcmg.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 02/09/2024]
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Saba L, Cau R, Murgia A, Nicolaides AN, Wintermark M, Castillo M, Staub D, Kakkos SK, Yang Q, Paraskevas KI, Yuan C, Edjlali M, Sanfilippo R, Hendrikse J, Johansson E, Mossa-Basha M, Balu N, Dichgans M, Saloner D, Bos D, Jager HR, Naylor R, Faa G, Suri JS, Costello J, Auer DP, Mcnally JS, Bonati LH, Nardi V, van der Lugt A, Griffin M, Wasserman BA, Kooi ME, Gillard J, Lanzino G, Mikhailidis DP, Mandell DM, Benson JC, van Dam-Nolen DHK, Kopczak A, Song JW, Gupta A, DeMarco JK, Chaturvedi S, Virmani R, Hatsukami TS, Brown M, Moody AR, Libby P, Schindler A, Saam T. Carotid Plaque-RADS: A Novel Stroke Risk Classification System. JACC Cardiovasc Imaging 2024; 17:62-75. [PMID: 37823860 DOI: 10.1016/j.jcmg.2023.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Carotid artery atherosclerosis is highly prevalent in the general population and is a well-established risk factor for acute ischemic stroke. Although the morphological characteristics of vulnerable plaques are well recognized, there is a lack of consensus in reporting and interpreting carotid plaque features. OBJECTIVES The aim of this paper is to establish a consistent and comprehensive approach for imaging and reporting carotid plaque by introducing the Plaque-RADS (Reporting and Data System) score. METHODS A panel of experts recognized the necessity to develop a classification system for carotid plaque and its defining characteristics. Using a multimodality analysis approach, the Plaque-RADS categories were established through consensus, drawing on existing published reports. RESULTS The authors present a universal classification that is applicable to both researchers and clinicians. The Plaque-RADS score offers a morphological assessment in addition to the prevailing quantitative parameter of "stenosis." The Plaque-RADS score spans from grade 1 (indicating complete absence of plaque) to grade 4 (representing complicated plaque). Accompanying visual examples are included to facilitate a clear understanding of the Plaque-RADS categories. CONCLUSIONS Plaque-RADS is a standardized and reliable system of reporting carotid plaque composition and morphology via different imaging modalities, such as ultrasound, computed tomography, and magnetic resonance imaging. This scoring system has the potential to help in the precise identification of patients who may benefit from exclusive medical intervention and those who require alternative treatments, thereby enhancing patient care. A standardized lexicon and structured reporting promise to enhance communication between radiologists, referring clinicians, and scientists.
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Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, Italy.
| | - Riccardo Cau
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | | | - Andrew N Nicolaides
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus; Department of Vascular Surgery, Imperial College, London, United Kingdom
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Center, Houston, Texas, USA
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daniel Staub
- Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stavros K Kakkos
- Department of Vascular Surgery, University of Patras Medical School, Patras, Greece
| | - Qi Yang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Myriam Edjlali
- Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, CEA, CNRS, Inserm, Frédéric Joliot Hospital Department, Orsay, France; Department of Radiology, APHP, Paris, France
| | | | | | - Elias Johansson
- Clinical Science, Umeå University, Neurosciences, Umeå, Sweden
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - H Rolf Jager
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom
| | - Ross Naylor
- The Leicester Vascular Institute, Glenfield Hospital, Leicester, United Kingdom
| | - Gavino Faa
- Department of Pathology, University of Cagliari, Cagliari, Italy
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoin, Roseville, California, USA
| | - Justin Costello
- Department of Neuroradiology, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, and NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - J Scott Mcnally
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Leo H Bonati
- Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maura Griffin
- Vascular Screening and Diagnostic Centre, Nicosia, Cyprus
| | - Bruce A Wasserman
- Department of Radiology, University of Maryland School of Medicine and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Eline Kooi
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London School, University College London, London, United Kingdom
| | - Daniel M Mandell
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - John C Benson
- Department of Radiology Mayo Clinic, Rochester, Minnesota, USA
| | - Dianne H K van Dam-Nolen
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ajay Gupta
- Department of Radiology Weill Cornell Medical College, New York, New York, USA
| | - J Kevin DeMarco
- Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Renu Virmani
- Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, Maryland, USA
| | | | - Martin Brown
- Department of Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Alan R Moody
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas Schindler
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Saam
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Die Radiologie, Rosenheim, Germany
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Patzig M, Forbrig R, Küpper C, Eren OE, Masouris I, Saam T, Kellert L, Liebig T, Schöberl F. Erratum to 'Evaluation of vessel-wall contrast-enhancement on high-resolution MRI in European patients with Moyamoya disease' [Journal of Stroke and Cerebrovascular Diseases Volume 32, Issue 6, June 2023, 107135]. J Stroke Cerebrovasc Dis 2023; 32:107187. [PMID: 37230818 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Maximilian Patzig
- Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany; Radiologie Augsburg Friedberg, Augsburg, Germany.
| | - Robert Forbrig
- Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Clemens Küpper
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany
| | - Ozan Emre Eren
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany
| | - Ilias Masouris
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany
| | - Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Germany; Die Radiologie, Rosenheim, Germany
| | - Lars Kellert
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany
| | - Thomas Liebig
- Institute of Diagnostic and Interventional Neuroradiology, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Florian Schöberl
- Department of Neurology, Ludwig-Maximilians-University Munich, Germany
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Strecker C, Kopczak A, Saam T, Sepp D, Hennemuth A, Mayerhofer E, Poli S, Ziemann U, Poppert H, Schindler A, Harloff A. Carotid geometry is independently associated with complicated carotid artery plaques. Front Cardiovasc Med 2023; 10:1177998. [PMID: 37378412 PMCID: PMC10291134 DOI: 10.3389/fcvm.2023.1177998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Complicated carotid artery plaques (cCAPs) are associated with an increased risk of rupture and subsequent stroke. The geometry of the carotid bifurcation determines the distribution of local hemodynamics and could thus contribute to the development and composition of these plaques. Therefore, we studied the role of carotid bifurcation geometry in the presence of cCAPs. Methods We investigated the association of individual vessel geometry with carotid artery plaque types in the Carotid Plaque Imaging in Acute Stroke (CAPIAS) study. After excluding arteries without plaque or with insufficient MRI quality, 354 carotid arteries from 182 patients were analyzed. Individual parameters of carotid geometry [i.e., internal carotid artery (ICA)/common carotid artery (CCA) ratio, bifurcation angle, and tortuosity) were derived from time-of-flight MR images. The lesion types of carotid artery plaques were determined according to the American Heart Association classification of lesions by multi-contrast 3T-MRI. The association between carotid geometry and a cCAP was studied using logistic regression after adjusting for age, sex, wall area, and cardiovascular risk factors. Results Low ICA/CCA ratios (OR per SD increase 0.60 [95%CI: 0.42-0.85]; p = 0.004) and low bifurcation angles (OR 0.61 [95%CI: 0.42-0.90]; p = 0.012) were significantly associated with the presence of cCAPs after adjusting for age, sex, cardiovascular risk factors, and wall area. Tortuosity had no significant association with cCAPs. Only ICA/CCA ratio remained significant in a model containing all three geometric parameters (OR per SD increase 0.65 [95%CI: 0.45-0.94]; p = 0.023). Conclusions A steep tapering of the ICA relative to the CCA and, to a lesser extent, a low angle of the carotid bifurcation were associated with the presence of cCAPs. Our findings highlight the contribution of bifurcation geometry to plaque vulnerability. Thus, assessment of carotid geometry could be helpful in identifying patients at risk of cCAPs.
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Affiliation(s)
- Christoph Strecker
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | | | - Dominik Sepp
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Anja Hennemuth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ernst Mayerhofer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Sven Poli
- Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Holger Poppert
- Department of Neurology, Helios Klinikum München West, Munich, Germany
| | - Andreas Schindler
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kopczak A, Schindler A, Sepp D, Bayer-Karpinska A, Malik R, Koch ML, Zeller J, Strecker C, Janowitz D, Wollenweber FA, Hempel JM, Boeckh-Behrens T, Cyran CC, Helck A, Harloff A, Ziemann U, Poli S, Poppert H, Saam T, Dichgans M. Complicated Carotid Artery Plaques and Risk of Recurrent Ischemic Stroke or TIA. J Am Coll Cardiol 2022; 79:2189-2199. [PMID: 35523659 DOI: 10.1016/j.jacc.2022.03.376] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/31/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke. OBJECTIVES The purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA). METHODS The CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA. RESULTS Among 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years; P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years; P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P = 0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke. CONCLUSIONS Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933).
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Affiliation(s)
- Anna Kopczak
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Schindler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Department of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Dominik Sepp
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Klinikum Fürstenfeldbruck, Neurology, Fürstenfeldbruck, Germany
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Mia L Koch
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Julia Zeller
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christoph Strecker
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Department of Neurology, Helios Dr Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | - Johann-Martin Hempel
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Helck
- Radiology and Neuroradiology Zurich, Hirslanden/Klinik im Park, Zurich, Switzerland
| | - Andreas Harloff
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Holger Poppert
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany; Department of Neurology, Helios Klinikum München West, Munich, Germany
| | - Tobias Saam
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Radiologisches Zentrum Rosenheim, Rosenheim, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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Saba L, Brinjikji W, Spence JD, Wintermark M, Castillo M, Borst GJD, Yang Q, Yuan C, Buckler A, Edjlali M, Saam T, Saloner D, Lal BK, Capodanno D, Sun J, Balu N, Naylor R, Lugt AVD, Wasserman BA, Kooi ME, Wardlaw J, Gillard J, Lanzino G, Hedin U, Mikulis D, Gupta A, DeMarco JK, Hess C, Goethem JV, Hatsukami T, Rothwell P, Brown MM, Moody AR. Roadmap Consensus on Carotid Artery Plaque Imaging and Impact on Therapy Strategies and Guidelines: An International, Multispecialty, Expert Review and Position Statement. AJNR Am J Neuroradiol 2021; 42:1566-1575. [PMID: 34326105 DOI: 10.3174/ajnr.a7223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/26/2021] [Indexed: 12/19/2022]
Abstract
Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.
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Affiliation(s)
- L Saba
- From the Department of Radiology (L.S.), University of Cagliari, Cagliari, Italy
| | | | - J D Spence
- Stroke Prevention and Atherosclerosis Research Centre (J.D.S.), Robarts Research Institute, Western University, London, Ontario, Canada
| | - M Wintermark
- Department of Neuroradiology (M.W.), Stanford University and Healthcare System, Stanford, California
| | - M Castillo
- Department of Radiology (M.C.), University of North Carolina, Chapel Hill, North Carolina
| | - G J D Borst
- Department of Vascular Surgery (G.J.D.B.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Q Yang
- Department of Radiology (Q.Y.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - C Yuan
- Departments of Radiology (C.Y., J.S., N.B.)
| | - A Buckler
- Elucid Bioimaging (A.B.), Boston, Massachusetts
| | - M Edjlali
- Department of Neuroradiology (M.E.), Université Paris-Descartes-Sorbonne-Paris-Cité, IMABRAIN-INSERM-UMR1266, DHU-Neurovasc, Centre Hospitalier Sainte-Anne, Paris, France
| | - T Saam
- Department of Radiology (T.S.), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Radiologisches Zentrum (T.S.), Rosenheim, Germany
| | - D Saloner
- Departments of Radiology and Biomedical Imaging (D.S., C.H.), University of California San Francisco, San Francisco, California
| | - B K Lal
- Department of Vascular Surgery (B.K.L.), University of Maryland School of Medicine, Baltimore, Maryland
| | - D Capodanno
- Division of Cardiology (D.C.), A.O.U. Policlinico "G. Rodolico-San Marco," University of Catania, Italy
| | - J Sun
- Departments of Radiology (C.Y., J.S., N.B.)
| | - N Balu
- Departments of Radiology (C.Y., J.S., N.B.)
| | - R Naylor
- The Leicester Vascular Institute (R.N.), Glenfield Hospital, Leicester, UK
| | - A V D Lugt
- Department of Radiology and Nuclear Medicine (A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Science (B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - M E Kooi
- Department of Radiology and Nuclear Medicine (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J Wardlaw
- Centre for Clinical Brain Sciences (J.W.), United Kingdom Dementia Research Institute and Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - J Gillard
- Christ's College (J.G.), Cambridge, UK
| | - G Lanzino
- Neurosurgery (G.L.) Mayo Clinic, Rochester, Minnesota
| | - U Hedin
- Department of Molecular Medicine and Surgery (U.H.), Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery (U.H.), Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden
| | - D Mikulis
- Joint Department of Medical Imaging and the Functional Neuroimaging Laboratory (D.M.), University Health Network, Toronto, Ontario, Canada
| | - A Gupta
- Department of Radiology (A.G.), Weill Cornell Medical College, New York, New York
| | - J K DeMarco
- Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences (J.K.D.), Bethesda, Maryland
| | - C Hess
- Departments of Radiology and Biomedical Imaging (D.S., C.H.), University of California San Francisco, San Francisco, California
| | - J V Goethem
- Faculty of Biomedical Sciences (J.V.G.), University of Antwerp, Antwerp, Belgium
| | - T Hatsukami
- Surgery (T.H.), University of Washington, Seattle, Washington
| | - P Rothwell
- Centre for Prevention of Stroke and Dementia (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - M M Brown
- Stroke Research Centre (M.M.B.), Department of Brain Repair and Rehabilitation, University College of London Queen Square Institute of Neurology, University College London, UK
| | - A R Moody
- Department of Medical Imaging (A.R.M.), University of Toronto, Toronto, Ontario, Canada
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Kopczak A, Schindler A, Dichgans M, Saam T. Reply: Comparison of Different Plaque Imaging Techniques to Detect Complicated Carotid Artery Plaques. J Am Coll Cardiol 2021; 77:1147-1148. [PMID: 33632492 DOI: 10.1016/j.jacc.2020.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
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Froelich MF, Fugmann M, Daldrup CL, Hetterich H, Coppenrath E, Saam T, Ferrari U, Seissler J, Popp D, Lechner A, Sommer NN. Measurement of total and visceral fat mass in young adult women: a comparison of MRI with anthropometric measurements with and without bioelectrical impedance analysis. Br J Radiol 2020; 93:20190874. [PMID: 32142376 PMCID: PMC10993227 DOI: 10.1259/bjr.20190874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE MRI is established for measurement of body fat mass (FM) and abdominal visceral adipose tissue (VAT). Anthropometric measurements and bioelectrical impedance analysis (BIA) have been proposed as surrogates to estimation by MRI. Aim of this work is to assess the predictive value of these methods for FM and VAT measured by MRI. METHODS Patients were selected from cohort study PPS-Diab (prediction, prevention and subclassification of Type 2 diabetes). Total FM and VAT were quantified by MRI and BIA together with clinical variables like age, waist and hip circumference and height. Least-angle regressions were utilized to select anthropometric and BIA parameters for their use in multivariable linear regression models to predict total FM and VAT. Bland-Altman plots, Pearson correlation coefficients, Wilcoxon signed-rank tests and univariate linear regression models were applied. RESULTS 116 females with 35 ± 3 years and a body mass index of 25.1 ± 5.3 kg/m2 were included into the analysis. A multivariable model revealed weight (β = 0.516, p < 0.001), height (β = -0.223, p < 0.001) and hip circumference (β = 0.156, p = 0.003) as significantly associated with total FM measured by MRI. A additional multivariable model also showed a significant predictive value of FMBIA (β = 0.583, p < 0.001) for FM. In addition, waist circumference (β = 0.054, p < 0.001), weight (β = 0.016, p = 0.031) in one model and FMBIA (β = 0.026, p = 0.018) in another model were significantly associated with VAT quantified by MRI. However, deviations reached more than 5 kg for total FM and more than 1 kg for VAT. CONCLUSION Anthropometric measurements and BIA show significant association with total FM and VAT. ADVANCES IN KNOWLEDGE As these measurements show significant deviations from the absolute measured values determined by MRI, MRI should be considered the gold-standard for quantification.
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Affiliation(s)
- Matthias F. Froelich
- Department of Radiology, University Hospital,
LMU Munich, Germany
- Institute of Clinical Radiology and Nuclear Medicine,
University Medical Center Mannheim,
Mannheim, Germany
| | - Marina Fugmann
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV,
Klinikum der Universität München,
Ludwig-Maximilians-Universität München,
Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum
München, Munich,
Germany
- German Center for Diabetes Research (DZD),
Munich, Germany
| | | | - Holger Hetterich
- Department of Radiology, University Hospital,
LMU Munich, Germany
| | - Eva Coppenrath
- Department of Radiology, University Hospital,
LMU Munich, Germany
| | - Tobias Saam
- Department of Radiology, University Hospital,
LMU Munich, Germany
| | - Uta Ferrari
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV,
Klinikum der Universität München,
Ludwig-Maximilians-Universität München,
Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum
München, Munich,
Germany
- German Center for Diabetes Research (DZD),
Munich, Germany
| | - Jochen Seissler
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV,
Klinikum der Universität München,
Ludwig-Maximilians-Universität München,
Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum
München, Munich,
Germany
- German Center for Diabetes Research (DZD),
Munich, Germany
| | - Daniel Popp
- Department of Radiology, University Hospital,
LMU Munich, Germany
| | - Andreas Lechner
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV,
Klinikum der Universität München,
Ludwig-Maximilians-Universität München,
Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum
München, Munich,
Germany
- German Center for Diabetes Research (DZD),
Munich, Germany
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9
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Schindler A, Schinner R, Altaf N, Hosseini AA, Simpson RJ, Esposito-Bauer L, Singh N, Kwee RM, Kurosaki Y, Yamagata S, Yoshida K, Miyamoto S, Maggisano R, Moody AR, Poppert H, Kooi ME, Auer DP, Bonati LH, Saam T. Prediction of Stroke Risk by Detection of Hemorrhage in Carotid Plaques: Meta-Analysis of Individual Patient Data. JACC Cardiovasc Imaging 2020; 13:395-406. [PMID: 31202755 DOI: 10.1016/j.jcmg.2019.03.028] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/20/2019] [Accepted: 03/24/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goal of this study was to compare the risk of stroke between patients with carotid artery disease with and without the presence of intraplaque hemorrhage (IPH) on magnetic resonance imaging. BACKGROUND IPH in carotid stenosis increases the risk of cerebrovascular events. Uncertainty remains whether risk of stroke alone is increased and whether stroke is predicted independently of known risk factors. METHODS Data were pooled from 7 cohort studies including 560 patients with symptomatic carotid stenosis and 136 patients with asymptomatic carotid stenosis. Hazards of ipsilateral ischemic stroke (primary outcome) were compared between patients with and without IPH, adjusted for clinical risk factors. RESULTS IPH was present in 51.6% of patients with symptomatic carotid stenosis and 29.4% of patients with asymptomatic carotid stenosis. During 1,121 observed person-years, 66 ipsilateral strokes occurred. Presence of IPH at baseline increased the risk of ipsilateral stroke both in symptomatic (hazard ratio [HR]: 10.2; 95% confidence interval [CI]: 4.6 to 22.5) and asymptomatic (HR: 7.9; 95% CI: 1.3 to 47.6) patients. Among patients with symptomatic carotid stenosis, annualized event rates of ipsilateral stroke in those with IPH versus those without IPH were 9.0% versus 0.7% (<50% stenosis), 18.1% versus 2.1% (50% to 69% stenosis), and 29.3% versus 1.5% (70% to 99% stenosis). Annualized event rates among patients with asymptomatic carotid stenosis were 5.4% in those with IPH versus 0.8% in those without IPH. Multivariate analysis identified IPH (HR: 11.0; 95% CI: 4.8 to 25.1) and severe degree of stenosis (HR: 3.3; 95% CI: 1.4 to 7.8) as independent predictors of ipsilateral stroke. CONCLUSIONS IPH is common in patients with symptomatic and asymptomatic carotid stenosis and is a stronger predictor of stroke than any known clinical risk factors. Magnetic resonance imaging might help identify patients with carotid disease who would benefit from revascularization.
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Affiliation(s)
- Andreas Schindler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Department of Radiology, Trauma Center Murnau, Murnau, Germany
| | - Regina Schinner
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nishaf Altaf
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom; Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Akram A Hosseini
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom; Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Richard J Simpson
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom; Department of Vascular Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | - Navneet Singh
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Robert M Kwee
- Department of Radiology and Nuclear Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Robert Maggisano
- Department of Vascular Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Holger Poppert
- Department of Neurology, Technische Universität München, Munich, Germany
| | - M Eline Kooi
- Department of Radiology and Nuclear Medicine, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Leo H Bonati
- Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Tobias Saam
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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10
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Sommer NN, Pons Lucas R, Coppenrath E, Kooijman H, Galiè F, Hesse N, Sommer WH, Treitl KM, Saam T, Froelich MF. Contrast-enhanced modified 3D T1-weighted TSE black-blood imaging can improve detection of infectious and neoplastic meningitis. Eur Radiol 2019; 30:866-876. [PMID: 31691123 DOI: 10.1007/s00330-019-06475-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/30/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the diagnostic value of a contrast-enhanced 3D T1-weighted-modified volumetric isotropic turbo spin-echo acquisition sequence (T1-mVISTA) in comparison with a conventional 3D T1-weighted magnetization-prepared rapid gradient-echo (T1-MP-RAGE) sequence for the detection of meningeal enhancement in patients with meningitis. METHODS Thirty patients (infectious meningitis, n = 12; neoplastic meningitis, n = 18) and 45 matched controls were enrolled in this retrospective case-control study. Sets of randomly selected T1-mVISTA and T1-MP-RAGE images (both with 0.8-mm isotropic resolution) were read separately 4 weeks apart. Image quality, leptomeningeal and dural enhancement, grading of visual contrast enhancement, and diagnostic confidence were compared using the Kruskal-Wallis rank sum test. RESULTS Image quality was rated to be good to excellent in 75 out of 75 cases (100%) for T1-mVISTA and 74 out of 75 cases (98.7%) for T1-MP-RAGE. T1-mVISTA detected significantly more patients with leptomeningeal enhancement (p = 0.006) compared with T1-MP-RAGE (86.7 vs. 50.0%, p < 0.001), each with specificity of 100%. Similarly, sensitivity of T1-mVISTA for the detection of dural and/or leptomeningeal enhancement was also significantly higher compared with that of T1-MP-RAGE (96.7 vs. 80.0%, p = 0.025) without significant differences regarding specificity (97.8 vs. 95.6%, p = 0.317). No significant differences were found for dural enhancement alone. Diagnostic confidence in T1-mVISTA was significantly higher (p = 0.01). Visual contrast enhancement was tendentially higher in T1-mVISTA. CONCLUSIONS T1-mVISTA may be an adequate and probably better alternative to T1-MP-RAGE for detection of leptomeningeal diseases. KEY POINTS • Black-blood T1-mVISTA showed a significant higher sensitivity for the detection of leptomeningeal enhancement compared with MP-RAGE without losses regarding specificity. • Diagnostic confidence was assessed significantly higher in T1-mVISTA. • T1-mVISTA should be considered a supplement or an alternative to T1-MP-RAGE in patients with suspected leptomeningeal diseases.
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Affiliation(s)
- Nora Navina Sommer
- Department of Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstr. 1, 80336, Munich, Germany.
| | - Romina Pons Lucas
- Department of Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstr. 1, 80336, Munich, Germany
| | - Eva Coppenrath
- Department of Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstr. 1, 80336, Munich, Germany
| | | | - Franziska Galiè
- Department of Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstr. 1, 80336, Munich, Germany
| | - Nina Hesse
- Department of Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstr. 1, 80336, Munich, Germany
| | - Wieland H Sommer
- Department of Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstr. 1, 80336, Munich, Germany
| | - Karla M Treitl
- Department of Radiology, Ludwig-Maximilians-University Hospital, Ziemssenstr. 1, 80336, Munich, Germany.,German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Tobias Saam
- Radiologisches Zentrum Rosenheim, Stollstr. 6, 83022, Rosenheim, Germany
| | - Matthias F Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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11
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Maurus S, Sommer NN, Kooijman H, Coppenrath E, Witt M, Schulze-Koops H, Czihal M, Hoffmann U, Saam T, Treitl KM. 3D black-blood 3T-MRI for the diagnosis of abdominal large vessel vasculitis. Eur Radiol 2019; 30:1041-1044. [PMID: 31529250 DOI: 10.1007/s00330-019-06432-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/27/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To assess the value of a T1-3D black-blood turbo spin echo (TSE) sequence for the diagnosis of abdominal large vessel vasculitis (LVV). MATERIALS AND METHODS The study included 20 patients with abdominal LVV and 17 controls, who underwent a 3T-MRI scan using a modified T1-3D volumetric isotropic TSE acquisition and a segmented T1-3D turbo field echo sequence (T1-mVISTA/T1-eTHRIVE). Two radiologists independently analyzed the aorta for concentric contrast enhancement, concentric wall thickening, image quality, and flow artifact intensity (CCE/CWT/IQ/FAI; 4-point scales). The mean aortic wall thickness (MAWT) in post-contrast T1-mVISTA was compared between patients and controls. RESULTS IQ of T1-mVISTA was rated good to excellent in 91.5% of 282 evaluated vessel segments with no or minor FAI present in 85.5%. The inter-observer reproducibility for the identification of CCE/CWT on T1-mVISTA was 0.92 and 0.93 (p < 0.001). The distribution of segmental inflammation in T1-mVISTA significantly correlated with T1-eTHRIVE (CCE, κ = 0.768; CWT, κ = 0.715; p < 0.001), resulting in a sensitivity, specificity, and positive predictive value of 100%, 81.3%, and 83.3%. The MAWT significantly differed between patients and controls (3.29 ± 0.81 vs. 2.24 ± 0.45 mm; p < 0.001). CONCLUSIONS T1-mVISTA enables the evaluation of the MAWT and allows the detection of abdominal LVV. KEY POINTS • 3D T1w-mVISTA accurately depicted the large abdominal vessels. • 3D T1w-mVISTA enables accurate measurements of the abdominal aortic wall thickness. • 3D T1w-mVISTA is useful for the detection of abdominal LVV.
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Affiliation(s)
- Stefan Maurus
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Nora N Sommer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | | | - Eva Coppenrath
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Witt
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, LMU Munich, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, University Hospital, LMU Munich, Munich, Germany
| | - Michael Czihal
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Saam
- Radiologisches Zentrum Rosenheim, Rosenheim, Germany
| | - Karla M Treitl
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Center for Cardiovascular Disease Research (DZHK e. V.), Munich, Germany
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12
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Saba L, Saam T, Jäger HR, Yuan C, Hatsukami TS, Saloner D, Wasserman BA, Bonati LH, Wintermark M. Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. Lancet Neurol 2019; 18:559-572. [PMID: 30954372 DOI: 10.1016/s1474-4422(19)30035-3] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/15/2023]
Abstract
Stroke represents a massive public health problem. Carotid atherosclerosis plays a fundamental part in the occurence of ischaemic stroke. European and US guidelines for prevention of stroke in patients with carotid plaques are based on quantification of the percentage reduction in luminal diameter due to the atherosclerotic process to select the best therapeutic approach. However, better strategies for prevention of stroke are needed because some subtypes of carotid plaques (eg, vulnerable plaques) can predict the occurrence of stroke independent of the degree of stenosis. Advances in imaging techniques have enabled routine characterisation and detection of the features of carotid plaque vulnerability. Intraplaque haemorrhage is accepted by neurologists and radiologists as one of the features of vulnerable plaques, but other characteristics-eg, plaque volume, neovascularisation, and inflammation-are promising as biomarkers of carotid plaque vulnerability. These biomarkers could change current management strategies based merely on the degree of stenosis.
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Affiliation(s)
- Luca Saba
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy.
| | - Tobias Saam
- Department of Radiology, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany; Radiologisches Zentrum Rosenheim, Rosenheim, Germany
| | - H Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Bruce A Wasserman
- The Russell H Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Leo H Bonati
- Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA, USA
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13
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Sommer NN, Treitl KM, Coppenrath E, Kooijman H, Dechant C, Czihal M, Kolben TM, Beyer SE, Sommer WH, Saam T. Three-Dimensional High-Resolution Black-Blood Magnetic Resonance Imaging for Detection of Arteritic Anterior Ischemic Optic Neuropathy in Patients With Giant Cell Arteritis. Invest Radiol 2018; 53:698-704. [DOI: 10.1097/rli.0000000000000500] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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14
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Popp D, Aertsen S, Luetke-Daldrup C, Coppenrath E, Hetterich H, Saam T, Rottenkolber M, Seissler J, Lechner A, Sommer NN. No Correlation of Pancreatic Fat and β-Cell Function in Young Women With and Without a History of Gestational Diabetes. J Clin Endocrinol Metab 2018; 103:3260-3266. [PMID: 29947782 DOI: 10.1210/jc.2018-00187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/21/2018] [Indexed: 01/11/2023]
Abstract
CONTEXT Pancreatic steatosis may contribute to β-cell dysfunction in type 2 diabetes (T2D), but data are controversial. Women who had gestational diabetes mellitus (GDM) are at high risk for developing T2D. OBJECTIVE To examine the association of pancreatic fat content with early/first-phase insulin secretion (as markers of β-cell function). DESIGN Cross-sectional analysis of a subcohort of the monocentric, prospective cohort study titled Prediction, Prevention, and Subclassification of Type 2 Diabetes. SETTING Ludwig Maximilians University Hospital, Munich, Germany. PARTICIPANTS Ninety-seven women, 3 to 16 months after pregnancy [41 normoglycemic women post-GDM, 19 women post-GDM with pathological glucose metabolism, and 37 normoglycemic women after a normoglycemic pregnancy (controls)]. MAIN OUTCOME MEASURES Correlation of MRI-measured pancreatic fat content with early insulin release in an oral glucose tolerance test (OGGT) [insulin increment within the first 30 minutes of the OGTT (IR30)] and first-phase insulin response (FPIR) in an intravenous glucose tolerance test (n = 65), both adjusted for insulin sensitivity index (ISI). RESULTS Pancreatic fat content did not correlate with IR30 and FPIR adjusted for ISI. It correlated positively with body mass index, waist circumference, liver fat, and intraabdominal fat volume. CONCLUSION Pancreatic fat content does not correlate with β-cell function in a cohort of young women with different degrees of T2D risk.
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Affiliation(s)
- Daniel Popp
- Klinik und Poliklinik für Radiologie, Ludwig Maximilians University Hospital, Munich, Germany
| | - Stephanie Aertsen
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University Hospital, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | | | - Eva Coppenrath
- Klinik und Poliklinik für Radiologie, Ludwig Maximilians University Hospital, Munich, Germany
| | - Holger Hetterich
- Klinik und Poliklinik für Radiologie, Ludwig Maximilians University Hospital, Munich, Germany
| | - Tobias Saam
- Klinik und Poliklinik für Radiologie, Ludwig Maximilians University Hospital, Munich, Germany
| | - Marietta Rottenkolber
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University Hospital, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Jochen Seissler
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University Hospital, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Andreas Lechner
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University Hospital, Munich, Germany
- Clinical Cooperation Group Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, Germany
- Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Nora N Sommer
- Klinik und Poliklinik für Radiologie, Ludwig Maximilians University Hospital, Munich, Germany
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15
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Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, Saam T, Moody AR, Li D, Matouk CC, Johnson MH, Jäger HR, Mossa-Basha M, Kooi ME, Fan Z, Saloner D, Wintermark M, Mikulis DJ, Wasserman BA. Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2018; 39:E9-E31. [PMID: 29326139 DOI: 10.3174/ajnr.a5488] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.
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Affiliation(s)
- L Saba
- From the Department of Medical Imaging (L.S.), University of Cagliari, Cagliari, Italy
| | - C Yuan
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - T Saam
- Department of Radiology (T.S.), Ludwig-Maximilian University Hospital, Munich, Germany
| | - A R Moody
- Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - D Li
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - C C Matouk
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - H R Jäger
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | | | - M E Kooi
- Department of Radiology (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Z Fan
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - D Saloner
- Department of Radiology and Biomedical Imaging (D.S.), University of California, San Francisco, California
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Division, Stanford University, Stanford, California
| | - D J Mikulis
- Division of Neuroradiology (D.J.M.), Department of Medical Imaging, University Health Network
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
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Hetterich H, Webber N, Willner M, Herzen J, Birnbacher L, Auweter S, Schüller U, Bamberg F, Notohamiprodjo S, Bartsch H, Wolf J, Marschner M, Pfeiffer F, Reiser M, Saam T. Dark-field imaging in coronary atherosclerosis. Eur J Radiol 2017; 94:38-45. [PMID: 28941758 DOI: 10.1016/j.ejrad.2017.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/21/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Dark-field imaging based on small angle X-ray scattering has been shown to be highly sensitive for microcalcifications, e.g. in breast tissue. We hypothesized (i) that high signal areas in dark-field imaging of atherosclerotic plaque are associated with microcalcifications and (ii) that dark-field imaging is more sensitive for microcalcifications than attenuation-based imaging. METHODS Fifteen coronary artery specimens were examined at an experimental set-up consisting of X-ray tube (40kV), grating-interferometer and detector. Tomographic dark-field-, attenuation-, and phase-contrast data were simultaneously acquired. Histopathology served as standard of reference. To explore the potential of dark field imaging in a full-body CT system, simulations were carried out with spherical calcifications of different sizes to simulate small and intermediate microcalcifications. RESULTS Microcalcifications were present in 10/10 (100%) cross-sections with high dark-field signal and without evidence of calcifications in attenuation- or phase contrast. In positive controls with high signal areas in all three modalities, 10/10 (100%) cross-sections showed macrocalcifications. In negative controls without high signal areas, no calcifications were detected. Simulations showed that the microcalcifications generate substantially higher dark-field than attenuation signal. CONCLUSIONS Dark-field imaging is highly sensitive for microcalcifications in coronary atherosclerotic plaque and might provide complementary information in the assessment of plaque instability.
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Affiliation(s)
- Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany.
| | - Nicole Webber
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Marian Willner
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Julia Herzen
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Lorenz Birnbacher
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Ulrich Schüller
- Center for Neuropathology, Ludwig-Maximilians-University Hospital, Munich, Germany; Institute for Neuropathology, University Medical Center Hamburg, Germany; Department for Pediatric Hematology and Oncology, University Medical Center Hamburg, Germany
| | - Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Susan Notohamiprodjo
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Harald Bartsch
- Institute of Pathology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Johannes Wolf
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Mathias Marschner
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Franz Pfeiffer
- Physics Department & Institute for Medical Engineering, Technical University Munich, Garching, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
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Eikendal ALM, den Ruijter HM, Haaring C, Saam T, van der Geest RJ, Westenberg JJM, Bots ML, Hoefer IE, Leiner T. Sex, body mass index, and blood pressure are related to aortic characteristics in healthy, young adults using magnetic resonance vessel wall imaging: the AMBITYON study. MAGMA 2017; 31:173-182. [PMID: 28569376 PMCID: PMC5813077 DOI: 10.1007/s10334-017-0626-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/12/2017] [Accepted: 05/12/2017] [Indexed: 12/31/2022]
Abstract
Objectives More detailed evaluation of atherosclerosis and its key determinants in young individuals is warranted to improve knowledge on the pathophysiology of its development and progression. This study evaluated associations of magnetic resonance imaging (MRI)-derived aortic wall area, wall thickness, and pulse wave velocity (PWV) with cardiovascular risk factors in asymptomatic, young adults. Materials and methods In 124 adults (age: 25–35 years) from the general population-based Atherosclerosis Monitoring and Biomarker Measurements in the Young study, demography, anthropometry, and blood samples were collected. The studied MRI-parameters were measured using a 3.0T MRI system. Relations between cardiovascular risk factors and aortic characteristics were assessed using multivariable linear regression analyses. Results Mean age was 31.8 years, 47.6% was male. Aortic wall area was positively associated with age [β = 0.01, (95% confidence interval (CI) 2.00 × 10−3, 0.02), p = 0.01] and BMI [β = 0.01, (0.01, 0.02), p = 0.003] and negatively associated with sex (reference: men) [β = −0.06, (−0.11, −0.01), p = 0.02]. Natural logarithm transformed (ln) aortic wall thickness was positively associated with BMI [β = 0.01, (1.00 × 10−3, 0.02), p = 0.02]. Ln aortic PWV was positively associated with 10 mmHg increment of SBP [β = 0.06, (0.03, 0.09), p < 0.001] and DBP [β = 0.06, (0.02, 0.09), p = 0.006]. No relations were observed for smoking and lipids. Conclusions Already in early adulthood, aortic wall geometry and stiffness vary by age, sex, BMI, and blood pressure.
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Affiliation(s)
- Anouk L M Eikendal
- Department of Radiology (E01.132), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Cees Haaring
- Department of Radiology (E01.132), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377, Munich, Germany
| | - Rob J van der Geest
- Division of Image Processing, Department of Radiology, 1-C2S Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jos J M Westenberg
- Division of Image Processing, Department of Radiology, 1-C2S Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Imo E Hoefer
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology (E01.132), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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18
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Coppenrath E, Lenz O, Sommer N, Lummel N, Linn J, Treitl K, Bamberg F, Reiser M, Pfefferkorn T, Saam T. Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study. ROFO-FORTSCHR RONTG 2017; 189:624-631. [PMID: 28445914 DOI: 10.1055/s-0043-104632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD). Methods 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2*w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision. Results 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0.94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0. Conclusion iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD. Key points · Intraluminal contrast enhancement is associated with cerebral ischemia in corresponding vessel territories in patients with cervical artery dissection.. · Our results suggest that intraluminal contrast enhancement represents intraluminal thrombus formation.. · Black-blood imaging might be useful to identify those patients with cervical artery dissection at higher risk for initial or recurrent stroke.. Citation Format · Coppenrath E, Lenz O, Sommer N et al. Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study. Fortschr Röntgenstr 2017; 189: 624 - 631.
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Affiliation(s)
- Eva Coppenrath
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Olga Lenz
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nora Sommer
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nina Lummel
- Institute of Neuroradiology and Interventional Neuroradiology, University Hospital Klinikum rechts der Isar Munich, Munich, Germany
| | - Jennifer Linn
- Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Karla Treitl
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Fabian Bamberg
- Diagnostical and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas Pfefferkorn
- Interdisciplinary Stroke Center Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias Saam
- Radiology Center Rosenheim, Rosenheim, Germany
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19
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Schindler A, Schinner R, Altaf N, Kooi M, Moody A, Poppert H, Reiser M, Auer D, Saam T. Der Einfluss von in der MRT-detektierten, eingebluteten Karotisplaques auf das erstmalige oder wiederholte Auftreten zerebrovaskulärer Ereignisse: eine Individuen-basierte Metaanalyse (Big Data). ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Schindler
- Klinikum der LMU München, Institut für klinische Radiologie, München
| | - R Schinner
- Klinikum der LMU München, Institut für klinische Radiologie, München
| | - N Altaf
- The University of Nottingham, Radiological Sciences, Nottingham
| | - M Kooi
- Maastricht University, Department of Radiology, Maastricht
| | - A Moody
- University of Toronto, Department of medical imaging, Toronto
| | - H Poppert
- TU München, Neurologische Klinik, München
| | - M Reiser
- Klinikum der LMU München, Institut für klinische Radiologie, München
| | - D Auer
- The University of Nottingham, Radiological Sciences, Nottingham
| | - T Saam
- Klinikum der LMU München, Institut für klinische Radiologie, München
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20
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Paprottka KJ, Saam D, Rübenthaler J, Schindler A, Sommer NN, Paprottka PM, Clevert DA, Reiser M, Saam T, Helck A. Prevalence and distribution of calcified nodules in carotid arteries in correlation with clinical symptoms. Radiol Med 2017; 122:449-457. [PMID: 28236046 DOI: 10.1007/s11547-017-0740-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Calcified nodules ("CN") are responsible for up to 5% of coronary-infarcts and, therefore, classified as minor criteria of "vulnerable" atherosclerotic plaque. We sought to evaluate prevalence and distribution of CN in carotid arteries in correlation with clinical symptoms. METHODS 178 consecutive patients with unilateral ischemic stroke and carotid plaques ≥2 mm by duplex ultrasound underwent a carotid-black-blood-3T-MRI with fat-saturated pre- and post-contrast T1w-, PDw-, T2w- and TOF images using dedicated surface-coils. CN were defined as distinct calcification with an irregular, protruding, and convex luminal surface. Prevalence of CN was determined in common carotid artery ("CCA") and internal carotid artery ("ICA") in consensus by two reviewers blinded to clinical information. RESULTS Thirty seven CN in 28 arteries of 26 patients were identified. Prevalence of CN in CCA compared to ICA was slightly higher (59 vs. 41%), but nearly similar in 66 arteries with ≥30% compared to 290 arteries with <30% stenosis (9.1 vs. 7.6%) and in the artery ipsilateral versus contralateral to stroke (7.9 vs. 7.9%; P values n.s.). Prevalence of CN was significantly higher in 40 symptomatic arteries with ≥30% stenosis compared to asymptomatic 26 arteries (15.6 vs. 0%; P = 0.04). There was a significantly higher prevalence of hypercholesterolemia and hypertension in patients with CN (57.7 vs. 36.0 and 88.5 vs. 66.7%; P values <0.05). CONCLUSION CN were found in 7.9% of arteries with carotid-plaques ≥2 mm by duplex-ultrasound; prevalence was significantly higher in symptomatic arteries with ≥30% stenosis compared to asymptomatic with <30% stenosis, suggesting that CN play a role in pathogenesis of ischemic stroke in a small subset of patients.
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Affiliation(s)
- Karolin Johanna Paprottka
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
| | - Damiana Saam
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Johannes Rübenthaler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Nora Navina Sommer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Philipp Marius Paprottka
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Dirk André Clevert
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Tobias Saam
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - Andreas Helck
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
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21
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Bamberg F, Hetterich H, Rospleszcz S, Lorbeer R, Auweter SD, Schlett CL, Schafnitzel A, Bayerl C, Schindler A, Saam T, Müller-Peltzer K, Sommer W, Zitzelsberger T, Machann J, Ingrisch M, Selder S, Rathmann W, Heier M, Linkohr B, Meisinger C, Weber C, Ertl-Wagner B, Massberg S, Reiser MF, Peters A. Subclinical Disease Burden as Assessed by Whole-Body MRI in Subjects With Prediabetes, Subjects With Diabetes, and Normal Control Subjects From the General Population: The KORA-MRI Study. Diabetes 2017; 66:158-169. [PMID: 27999110 DOI: 10.2337/db16-0630] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022]
Abstract
Detailed pathophysiological manifestations of early disease in the context of prediabetes are poorly understood. This study aimed to evaluate the extent of early signs of metabolic and cardio-cerebrovascular complications affecting multiple organs in individuals with prediabetes. Subjects without a history of stroke, coronary artery disease, or peripheral artery disease were enrolled in a case-control study nested within the Cooperative Health Research in the Region of Augsburg (KORA) FF4 cohort and underwent comprehensive MRI assessment to characterize cerebral parameters (white matter lesions, microbleeds), cardiovascular parameters (carotid plaque, left ventricular function, and myocardial late gadolinium enhancement [LGE]), and metabolic parameters (hepatic proton-density fat fraction [PDFF] and subcutaneous and visceral abdominal fat). Among 400 subjects who underwent MRI, 103 subjects had prediabetes and 54 had established diabetes. Subjects with prediabetes had an increased risk for carotid plaque and adverse functional cardiac parameters, including reduced early diastolic filling rates as well as a higher prevalence of LGE compared with healthy control subjects. In addition, people with prediabetes had significantly elevated levels of PDFF and total and visceral fat. Thus, subjects with prediabetes show early signs of subclinical disease that include vascular, cardiac, and metabolic changes, as measured by whole-body MRI after adjusting for cardiometabolic risk factors.
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Affiliation(s)
- Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
- German Center for Cardiovascular Disease Research, Munich, Germany
| | - Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
- German Center for Cardiovascular Disease Research, Munich, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Roberto Lorbeer
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
- German Center for Cardiovascular Disease Research, Munich, Germany
| | - Sigrid D Auweter
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anina Schafnitzel
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Christian Bayerl
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Andreas Schindler
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | | | - Wieland Sommer
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Tanja Zitzelsberger
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Jürgen Machann
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Centre Tübingen, Tübingen, Germany
- German Centre for Diabetes Research, Tübingen, Germany
| | - Michael Ingrisch
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Sonja Selder
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Christian Weber
- German Center for Cardiovascular Disease Research, Munich, Germany
- Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Birgit Ertl-Wagner
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Maximilian F Reiser
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Munich, Germany
| | - Annette Peters
- German Center for Cardiovascular Disease Research, Munich, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Cardiovascular Prevention, Ludwig-Maximilian-University Hospital, Munich, Germany
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22
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Treitl KM, Maurus S, Sommer NN, Kooijman-Kurfuerst H, Coppenrath E, Treitl M, Czihal M, Hoffmann U, Dechant C, Schulze-Koops H, Saam T. 3D-black-blood 3T-MRI for the diagnosis of thoracic large vessel vasculitis: A feasibility study. Eur Radiol 2016; 27:2119-2128. [PMID: 27510630 DOI: 10.1007/s00330-016-4525-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the feasibility of T1w-3D black-blood turbo spin echo (TSE) sequence with variable flip angles for the diagnosis of thoracic large vessel vasculitis (LVV). METHODS Thirty-five patients with LVV, diagnosed according to the current standard of reference, and 35 controls were imaged at 3.0T using 1.2 × 1.3 × 2.0 mm3 fat-suppressed, T1w-3D, modified Volumetric Isotropic TSE Acquisition (mVISTA) pre- and post-contrast. Applying a navigator and peripheral pulse unit triggering (PPU), the total scan time was 10-12 min. Thoracic aorta and subclavian and pulmonary arteries were evaluated for image quality (IQ), flow artefact intensity, diagnostic confidence, concentric wall thickening and contrast enhancement (CWT, CCE) using a 4-point scale. RESULTS IQ was good in all examinations (3.25 ± 0.72) and good to excellent in 342 of 408 evaluated segments (83.8 %), while 84.1 % showed no or minor flow artefacts. The interobserver reproducibility for the identification of CCE and CWT was 0.969 and 0.971 (p < 0.001) with an average diagnostic confidence of 3.47 ± 0.64. CCE and CWT were strongly correlated (Cohen's k = 0.87; P < 0.001) and significantly more frequent in the LVV-group (52.8 % vs. 1.0 %; 59.8 % vs. 2.4 %; P < 0.001). CONCLUSIONS Navigated fat-suppressed T1w-3D black-blood MRI with PPU-triggering allows diagnosis of thoracic LVV. KEY POINTS • Cross-sectional imaging is frequently applied in the diagnosis of LVV. • Navigated, PPU-triggered, T1w-3D mVISTA pre- and post contrast takes 10-12 min. • In this prospective, single-centre study, T1w-3D mVISTA accurately depicted large thoracic vessels. • T1w-3D mVISTA visualized CWT/CCW as correlates of mural inflammation in LVV. • T1w-3D mVISTA might be an alternative diagnostic tool without ionizing radiation.
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Affiliation(s)
- Karla Maria Treitl
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany. .,German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany.
| | - Stefan Maurus
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Nora Narvina Sommer
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | | | - Eva Coppenrath
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Marcus Treitl
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Michael Czihal
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Claudia Dechant
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Medical Clinic and Policlinic IV, LMU Munich, Pettenkoferstr. 8a, D-80336, Munich, Germany
| | - Tobias Saam
- Institute for Clinical Radiology, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany.,German Center for Cardiovascular Disease Research (DZHK e. V.), Pettenkoferstr. 8a, 80336, Munich, Germany
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23
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Eikendal ALM, Blomberg BA, Haaring C, Saam T, van der Geest RJ, Visser F, Bots ML, den Ruijter HM, Hoefer IE, Leiner T. 3D black blood VISTA vessel wall cardiovascular magnetic resonance of the thoracic aorta wall in young, healthy adults: reproducibility and implications for efficacy trial sample sizes: a cross-sectional study. J Cardiovasc Magn Reson 2016; 18:20. [PMID: 27075677 PMCID: PMC4831203 DOI: 10.1186/s12968-016-0237-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/22/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pre-clinical detection of atherosclerosis enables personalized preventive strategies in asymptomatic individuals. Cardiovascular magnetic resonance (CMR) has evolved as an attractive imaging modality for studying atherosclerosis in vivo. Yet, the majority of aortic CMR studies and proposed sequences to date have been performed at 1.5 tesla using 2D BB techniques and a slice thickness of 4-5 mm. Here, we evaluate for the first time the reproducibility of an isotropic, T1-weighted, three-dimensional, black-blood, CMR VISTA sequence (3D-T1-BB-VISTA) for quantification of aortic wall characteristics in healthy, young adults. METHODS In 20 healthy, young adults (10 males, mean age 31.3 years) of the AMBITYON cohort study the descending thoracic aorta was imaged with a 3.0 T MR system using the 3D-T1-BB-VISTA sequence. The inter-scan, inter-rater and intra-rater reproducibility of aortic lumen, total vessel and wall area and mean and maximum wall thickness was evaluated using Bland-Altman analyses and Intraclass Correlation Coefficients (ICC). Based on these findings, sample sizes for detecting differences in aortic wall characteristics between groups were calculated. RESULTS For each studied parameter, the inter-scan, inter-rater and intra-rater reproducibility was excellent as indicated by narrow limits of agreement and high ICCs (ranging from 0.76 to 0.99). Sample sizes required to detect a 5% difference in aortic wall characteristics between two groups were 203, 126, 136, 68 and 153 per group for lumen area, total vessel area and vessel wall area and for mean and maximum vessel wall thickness, respectively. CONCLUSION The 3D-T1-BB-VISTA sequence provides excellent reproducibility for quantification of aortic wall characteristics and can detect small differences between groups with reasonable sample sizes. Hence, it may be a valuable tool for assessment of the subtle vascular wall changes of early atherosclerosis in asymptomatic populations.
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Affiliation(s)
- Anouk L. M. Eikendal
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Björn A. Blomberg
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Cees Haaring
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Tobias Saam
- />Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - Rob J. van der Geest
- />Division of Image Processing, Department of Radiology, 1-C2S Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Fredy Visser
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- />Philips Healthcare, Veenpluis 4-6, 5684PC Best, The Netherlands
| | - Michiel L. Bots
- />Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Hester M. den Ruijter
- />Laboratory of Experimental Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Imo E. Hoefer
- />Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Tim Leiner
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Saam T, Habs M, Buchholz M, Schindler A, Bayer-Karpinska A, Cyran CC, Yuan C, Reiser M, Helck A. Expansive arterial remodeling of the carotid arteries and its effect on atherosclerotic plaque composition and vulnerability: an in-vivo black-blood 3T CMR study in symptomatic stroke patients. J Cardiovasc Magn Reson 2016; 18:11. [PMID: 26940800 PMCID: PMC4778304 DOI: 10.1186/s12968-016-0229-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/10/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Based on intravascular ultrasound of the coronary arteries expansive arterial remodeling is supposed to be a feature of the vulnerable atheroslerotic plaque. However, till now little is known regarding the clinical impact of expansive remodeling of carotid lesions. Therefore, we sought to evaluate the correlation of expansive arterial remodeling of the carotid arteries with atherosclerotic plaque composition and vulnerability using in-vivo Cardiovascular Magnetic Resonance (CMR). METHODS One hundred eleven symptomatic patients (74 male/71.8 ± 10.3y) with acute unilateral ischemic stroke and carotid plaques of at least 2 mm thickness were included. All patients received a dedicated multi-sequence black-blood carotid CMR (3Tesla) of the proximal internal carotid arteries (ICA). Measurements of lumen, wall, outer wall, hemorrhage, calcification and necrotic core were determined. Each vessel-segment was classified according to American Heart Association (AHA) criteria for vulnerable plaque. A modified remodeling index (mRI) was established by dividing the average outer vessel area of the ICA segments by the lumen area measured on TOF images in a not affected reference segment at the distal ipsilateral ICA. Correlations of mRI and clinical symptoms as well as plaque morphology/vessel dimensions were evaluated. RESULTS Seventy-eight percent (157/202) of all internal carotid arteries showed atherosclerotic disease with AHA Lesion-Type (LT) III or higher. The mRI of the ICA was significantly different in normal artery segments (AHA LT I; mRI 1.9) compared to atherosclerotic segments (AHA LT III-VII; mRI 2.5; p < 0.0001). Between AHA LT III-VII there was no significant difference of mRI. Significant correlations (p < 0.05) of the mRI with lumen-area (LA), wall-area (WA), vessel-area (VA) and wall-thickness (WT), necrotic-core area (NC), and ulcer-area were observed. With respect to clinical presentation (symptomatic/asymptomatic side) and luminal narrowing (stenotic/non-stenotic) no relevant correlations or significant differences regarding the mRI were found. CONCLUSION Expansive arterial remodeling exists in the ICA. However, no significant association between expansive arterial remodeling, stroke symptoms, complicated AHA VI plaque, and luminal stenosis could be established. Hence, results of our study suggest that expansive arterial remodeling is not a very practical marker for plaque vulnerability in the carotid arteries.
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Affiliation(s)
- Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr.15, 81377, Munich, Germany.
| | - Maximilian Habs
- Department of Neurology, Ludwig-Maximilians-University Hospital, Munich, Germany.
| | - Martin Buchholz
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr.15, 81377, Munich, Germany.
| | - Andreas Schindler
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr.15, 81377, Munich, Germany.
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital, Munich, Germany.
| | - Clemens C Cyran
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr.15, 81377, Munich, Germany.
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Maximilian Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr.15, 81377, Munich, Germany.
| | - Andreas Helck
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr.15, 81377, Munich, Germany.
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Schwarz F, Strobl FF, Cyran CC, Helck AD, Hartmann M, Schindler A, Nikolaou K, Reiser MF, Saam T. Reproducibility and differentiation of cervical arteriopathies using in vivo high-resolution black-blood MRI at 3 T. Neuroradiology 2016; 58:569-576. [DOI: 10.1007/s00234-016-1665-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/12/2016] [Indexed: 12/22/2022]
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Hyafil F, Schindler A, Sepp D, Obenhuber T, Bayer-Karpinska A, Boeckh-Behrens T, Höhn S, Hacker M, Nekolla SG, Rominger A, Dichgans M, Schwaiger M, Saam T, Poppert H. High-risk plaque features can be detected in non-stenotic carotid plaques of patients with ischaemic stroke classified as cryptogenic using combined (18)F-FDG PET/MR imaging. Eur J Nucl Med Mol Imaging 2015; 43:270-279. [PMID: 26433367 DOI: 10.1007/s00259-015-3201-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/17/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to investigate in 18 patients with ischaemic stroke classified as cryptogenic and presenting non-stenotic carotid atherosclerotic plaques the morphological and biological aspects of these plaques with magnetic resonance imaging (MRI) and (18)F-fluoro-deoxyglucose positron emission tomography ((18)F-FDG PET) imaging. METHODS Carotid arteries were imaged 150 min after injection of (18)F-FDG with a combined PET/MRI system. American Heart Association (AHA) lesion type and plaque composition were determined on consecutive MRI axial sections (n = 460) in both carotid arteries. (18)F-FDG uptake in carotid arteries was quantified using tissue to background ratio (TBR) on corresponding PET sections. RESULTS The prevalence of complicated atherosclerotic plaques (AHA lesion type VI) detected with high-resolution MRI was significantly higher in the carotid artery ipsilateral to the ischaemic stroke as compared to the contralateral side (39 vs 0 %; p = 0.001). For all other AHA lesion types, no significant differences were found between ipsilateral and contralateral sides. In addition, atherosclerotic plaques classified as high-risk lesions with MRI (AHA lesion type VI) were associated with higher (18)F-FDG uptake in comparison with other AHA lesions (TBR = 3.43 ± 1.13 vs 2.41 ± 0.84, respectively; p < 0.001). Furthermore, patients presenting at least one complicated lesion (AHA lesion type VI) with MRI showed significantly higher (18)F-FDG uptake in both carotid arteries (ipsilateral and contralateral to the stroke) in comparison with carotid arteries of patients showing no complicated lesion with MRI (mean TBR = 3.18 ± 1.26 and 2.80 ± 0.94 vs 2.19 ± 0.57, respectively; p < 0.05) in favour of a diffuse inflammatory process along both carotid arteries associated with complicated plaques. CONCLUSION Morphological and biological features of high-risk plaques can be detected with (18)F-FDG PET/MRI in non-stenotic atherosclerotic plaques ipsilateral to the stroke, suggesting a causal role for these plaques in stroke. Combined (18)F-FDG PET/MRI systems might help in the evaluation of patients with ischaemic stroke classified as cryptogenic.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. .,Department of Nuclear Medicine, Bichat University Hospital, Inserm 1148, DHU FIRE, Assistance Publique - Hôpitaux de Paris, Paris, France.
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Dominik Sepp
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tilman Obenhuber
- Institute for Clinical Radiology, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Sabine Höhn
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Axel Rominger
- Department of Nuclear Medicine, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Martin Dichgans
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tobias Saam
- Institute for Clinical Radiology, Ludwig Maximilians University Hospital Munich, Munich, Germany
| | - Holger Poppert
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Kammer NN, Coppenrath E, Treitl KM, Kooijman H, Dietrich O, Saam T. Comparison of contrast-enhanced modified T1-weighted 3D TSE black-blood and 3D MP-RAGE sequences for the detection of cerebral metastases and brain tumours. Eur Radiol 2015; 26:1818-25. [PMID: 26334511 DOI: 10.1007/s00330-015-3975-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/24/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare a modified T1-weighted 3D TSE black-blood sequence with sub-millimetre resolution (T1-mVISTA) with a magnetization-prepared rapid gradient echo (MP-RAGE) sequence for the diagnosis of cerebral malignomas. METHODS Forty-six patients with known or suspected intracranial tumours and 15 control patients were included in this retrospective study. All patients underwent T1-mVISTA (0.75-mm isotropic resolution, 4:43 min) and MP-RAGE (0.8-mm isotropic resolution, 4:46 minutes) at 3-Tesla in random order after application of contrast agent. Two experienced radiologists determined the number of lesions. Maximum diameter, diagnostic confidence (DC), visual assessment of contrast enhancement (VCE) and CNRlesion/parenchyma were assessed for each lesion. RESULTS Significantly more lesions were detected with T1-mVISTA compared to the MP-RAGE (61 vs. 36; p < 0.05). Further, DC and VCE was rated significantly higher in the T1-mVISTA (p < 0.05 and p < 0.001). Mean CNRlesion/parenchyma was twofold higher for T1-mVISTA (24.2 ± 17.5 vs. 12.7 ± 11.5, p < 0.001). The 25 lesions detected only in T1-mVISTA were significantly smaller than those detected in both sequences (4.3 ± 3.7 mm vs. 11.3 ± 10.7 mm; p < 0.01). CONCLUSIONS T1-mVISTA increases the contrast of lesions significantly compared to MP-RAGE and might therefore improve detection rates of small lesions in early stages of disease. KEY POINTS • T1-mVISTA leads to significantly higher contrast-to-noise ratios of cerebral malignomas. • T1-mVISTA detects significantly more metastatic lesions compared to 3D-MPRAGE. • Lesions detected only by T1-mVISTA are smaller than those detected in both sequences. • Diagnostic confidence is significantly higher for lesions detected by T1-mVISTA. • Application of T1-mVISTA might be of high relevance in early stages of disease.
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Affiliation(s)
- N N Kammer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany.
| | - E Coppenrath
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - K M Treitl
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - H Kooijman
- Philips Healthcare, Luebeckertordamm 5, 20099, Hamburg, Germany
| | - O Dietrich
- Josef Lissner Laboratory for Biomedical Imaging, Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Marchioninistr 15, 81377, Munich, Germany
| | - T Saam
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Nussbaumstr. 20, 80336, Munich, Germany
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Guenther SP, Cyran CC, Rominger A, Saam T, Kazmierzcak PM, Bagaev E, Pichlmaier M, Hagl C, Khaladj N. The relevance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography imaging in diagnosing prosthetic graft infections post cardiac and proximal thoracic aortic surgery. Interact Cardiovasc Thorac Surg 2015; 21:450-8. [DOI: 10.1093/icvts/ivv178] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
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Hagen CS, Saam T, Kammer N, Holzbach T, Giunta RE, Volkmer E. [Interrater Reliability of Scapholunate Advanced Collapse (SLAC) Wrist Stage Classification and Influence of Diagnostic Wrist Arthroscopy]. HANDCHIR MIKROCHIR P 2015; 47:175-81. [PMID: 26084857 DOI: 10.1055/s-0035-1550007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AIM Therapy of scapholunate advanced collapse (SLAC) wrist should be guided by the degree of arthritic changes within the radioscaphoid and midcarpal joints (stage 1-3 after Watson). Diagnostic investigations usually include X-ray imaging and wrist arthoscopy. In the present study, the interrater reliability of SLAC wrist stage classification by means of X-ray image analysis was evaluated between radiologists and hand surgeons. Ultimately, the influence of diagnostic wrist arthroscopy on the final stage classification was determined. PATIENTS AND METHODS Retrospectively, 38 SLAC wrists of 37 patients were included in this study. Conventional X-ray images in a dorso-palmar and lateral view were performed before diagnostic wrist arthroscopy. The degree of carpal collapse on X-rays was determined by 2 radiologists and 2 surgeons (1 board certified hand surgeon, 1 plastic surgeon, both experienced in hand surgery since years). After 14 days the stages were re-evaluated by the surgeons with the digital images from the wrist arthroscopies at hand. RESULTS While the interrater reliability turned out to be 'weak' amidst the radiologists, it was classified as 'light' among the surgeons. We found a 'weak' and a 'light' interrater reliability between the surgeons and the radiologists. Radiologists tended to assess the degree of severity higher than surgeons. The additional knowledge of the digital arthroscopy images led to a different classification in 55%. When X-rays were assessed in combination with the arthroscopy findings, both stage 1 and stage 3 were diagnosed less frequently. CONCLUSIONS Our study suggests that interpreting X-ray films alone is an unreliable method to assess the stage of SLAC wrist. We believe that additional diagnostic measures such as wrist arthroscopy are needed to accurately diagnose the SLAC wrist stage.
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Affiliation(s)
- C S Hagen
- Klinikum der LMU München, Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, München
| | - T Saam
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München
| | - N Kammer
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München
| | - T Holzbach
- Klinikum der LMU München, Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, München
| | - R E Giunta
- Klinikum der LMU München, Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, München
| | - E Volkmer
- Klinikum der LMU München, Handchirurgie, Plastische Chirurgie und Ästhetische Chirurgie, München
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Saam T, Maurus S, Kammer N, Kooijman H, Treitl M, Reiser M, Coppenrath E, Treitl K. Atem-getriggertes 3D-T1w-Black-Blood-MRT für die Diagnose der thorakalen Großgefäßvaskulitis: Eine Machbarkeitsstudie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hetterich H, Webber N, Willner M, Herzen J, Birnbacher L, Hipp A, Bamberg F, Pfeiffer F, Saam T. Klassifikation atherosklerotischer Plaques mittels gitterbasierter Phasenkontrast-Computertomografie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Treitl K, Treitl M, Kooijman-Kurfuerst H, Coppenrath E, Kammer N, Suderland E, Reiser M, Saam T. Evaluation einer T1-gewichteten 3D black-blood TSE Sequenz für die Diagnostik von tiefen Beinvenenthrombosen im Vergleich zu kontrastverstärkten Sequenzen und zur Sonografie: eine Pilot-Studie. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kammer N, Coppenrath E, Treitl K, Kooijman H, Reiser M, Saam T. 3D T1w-Black-Blood MRT in der Diagnostik zerebraler Metastasen bei 3.0 Tesla. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Grimm JM, Schindler A, Schwarz F, Cyran CC, Bayer-Karpinska A, Freilinger T, Yuan C, Linn J, Trelles M, Reiser MF, Nikolaou K, Saam T. Computed tomography angiography vs 3 T black-blood cardiovascular magnetic resonance for identification of symptomatic carotid plaques. J Cardiovasc Magn Reson 2014; 16:84. [PMID: 25315518 PMCID: PMC4189681 DOI: 10.1186/s12968-014-0084-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/23/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this prospective study was to perform a head-to-head comparison of the two methods most frequently used for evaluation of carotid plaque characteristics: Multi-detector Computed Tomography Angiography (MDCTA) and black-blood 3 T-cardiovascular magnetic resonance (bb-CMR) with respect to their ability to identify symptomatic carotid plaques. METHODS 22 stroke unit patients with unilateral symptomatic carotid disease and >50% stenosis by duplex ultrasound underwent MDCTA and bb-CMR (TOF, pre- and post-contrast fsT1w-, and fsT2w- sequences) within 15 days of symptom onset. Both symptomatic and contralateral asymptomatic sides were evaluated. By bb-CMR, plaque morphology, composition and prevalence of complicated AHA type VI lesions (AHA-LT6) were evaluated. By MDCTA, plaque type (non-calcified, mixed, calcified), plaque density in HU and presence of ulceration and/or thrombus were evaluated. Sensitivity (SE), specificity (SP), positive and negative predictive value (PPV, NPV) were calculated using a 2-by-2-table. RESULTS To distinguish between symptomatic and asymptomatic plaques AHA-LT6 was the best CMR variable and presence / absence of plaque ulceration was the best CT variable, resulting in a SE, SP, PPV and NPV of 80%, 80%, 80% and 80% for AHA-LT6 as assessed by bb-CMR and 40%, 95%, 89% and 61% for plaque ulceration as assessed by MDCTA. The combined SE, SP, PPV and NPV of bb-CMR and MDCTA was 85%, 75%, 77% and 83%, respectively. CONCLUSIONS Bb-CMR is superior to MDCTA at identifying symptomatic carotid plaques, while MDCTA offers high specificity at the cost of low sensitivity. Results were only slightly improved over bb-CMR alone when combining both techniques.
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Affiliation(s)
- Jochen M Grimm
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
- Department of Medical Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Andreas Schindler
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Florian Schwarz
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Clemens C Cyran
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Anna Bayer-Karpinska
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Tobias Freilinger
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Seattle, USA.
| | - Jennifer Linn
- Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Miguel Trelles
- Department of Radiology, University of Texas Medical Branch, Galveston, USA.
| | - Maximilian F Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Konstantin Nikolaou
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Tobias Saam
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
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Saam T, Hetterich H, Hoffmann VS, Bamberg F. Reply. J Am Coll Cardiol 2014; 63:2173-2174. [DOI: 10.1016/j.jacc.2014.02.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 01/27/2014] [Accepted: 02/04/2014] [Indexed: 11/29/2022]
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Saam T, Willner M, Fill S, Herzen J, Webber N, Hipp A, Reiser M, Pfeiffer F, Bamberg F, Hetterich H. Gewebecharakterisierung atherosklerotischer Plaque-Komponenten von Carotiden mittels quantitativer Phasenkontrast-Hounsfield-Einheiten. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Helck A, Bianda N, Ganton G, Yuan C, Reiser M, Gallino A, Wyttenbach R, Saam T. Intra-individueller Vergleich der Plaquemorphologie in den Karotiden und Femoralarterien mithilfe der nicht-invasiven MRT-Plaquebildgebung. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kammer N, Coppenrath E, Kooijman H, Reiser MF, Saam T. Whole Brain 3D-Black-Blood 3T-MRI: Eine Pilotstudie in der bildgebenden Diagnostik zerebraler Vaskulitiden. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Coppenrath E, Lenz O, Lummel N, Linn J, Bamberg F, Reiser MF, Dichgans M, Pfefferkorn T, Saam T. Klinische Wertigkeit der intraluminalen Thrombus-Kontrastmittelaufnahme bei Patienten mit spontaner cervicaler arterieller Dissektion. Eine in vivo Studie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kammer N, Lütke Daldrup C, Coppenrath E, Lechner A, Ferrari U, Reiser MF, Wirth S, Saam T, Hetterich H. Modifizierte mDixon Sequenzen im Vergleich mit H1-Spektroskopien zur Quantifizierung des Leberfettgehalts bei Patientinnen mit Gestationsdiabetes. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Saam T. Hands on grant writing. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Saam T, Eberhardt K, Buchholz M, Schindler A, Bayer-Karpinska A, Dichgans M, Reiser M, Nikolaou K, Trelles M. Evaluation der Karotis-CTA als Screening Methode für die Detektion komplizierter American Heart Association Typ VI Plaques. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hetterich H, Habbel C, Willner M, Herzen J, Saam T, Hipp A, Marschner M, Reiser M, Pfeiffer F, Bamberg F. Charakterisierung der koronaren Atherosklerose mittels röntgenbasierter Phasenkontrast-Computertomografie. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hetterich H, Willner M, Fill S, Herzen J, Bamberg F, Hipp A, Schüller U, Adam-Neumair S, Wirth S, Reiser M, Pfeiffer F, Saam T. Phase-contrast CT: qualitative and quantitative evaluation of atherosclerotic carotid artery plaque. Radiology 2014; 271:870-8. [PMID: 24588675 DOI: 10.1148/radiol.14131554] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the potential of phase-contrast computed tomography (CT) for atherosclerotic plaque imaging in human carotid arteries in an experimental ex vivo study. MATERIALS AND METHODS The study was approved by the institutional review board, and informed consent was obtained from the patients' relatives. Seven postmortem human carotid artery specimens were imaged at a laboratory setup by using a conventional x-ray tube and grating interferometer. After histologic processing, phase-contrast imaging and histopathologic data were matched. Characteristics of the necrotic core (NC) covered by a fibrous cap (FC), intraplaque hemorrhage (IPH), and calcifications (CAs) were established, and sensitivity, specificity, and accuracy of phase-contrast CT for plaque detection and the potential for accurate quantification were assessed. The Cohen κ and Pearson correlation coefficient R were used to determine the agreement between phase-contrast imaging and histopathologic findings for plaque characterization and correlation of quantitative plaque measurements, respectively. A difference with a P value of less than .05 was considered significant. RESULTS Characteristic criteria were found in all analyzed plaque components. Applying these criteria, phase-contrast CT had a good sensitivity for the detection of the FC and NC, IPH, and CAs (all, >80%) and excellent specificity and accuracy (all, >90%), with good interreader agreement (κ ≥ 0.72, P < .0001). There were excellent correlations for quantitative measurements of FC, NC, and CAs between phase-contrast imaging and histopathologic findings (R ≥ 0.92). Interreader reproducibility was excellent, with an intraclass correlation coefficient of 0.98 or higher for all measurements. CONCLUSION The results of this study indicate that ex vivo phase-contrast CT can help identify and quantify atherosclerotic plaque components, with excellent correlation to histopathologic findings. Although not yet applicable in vivo, phase-contrast CT may become a valuable tool to monitor atherosclerotic disease process noninvasively.
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Affiliation(s)
- Holger Hetterich
- From the Institute of Clinical Radiology (H.H., S.F., F.B., S.A., S.W., M.R., T.S.), Center for Neuropathology (U.S.), and Institute of Anatomy (S.A.), Ludwig-Maximilians-University Hospital, Pettenkoferstrasse 8a, 80336 Munich, Germany; {Department of Physics and Institute for Technical Medicine}, Technische Universität München, Garching, Germany (M.W., J.H., A.H., F.P.); and Institute of Materials Research, Helmholtz-Zentrum, Geesthacht, Germany (J.H.)
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Schindler A, Vliegenthart R, Schoepf UJ, Blanke P, Ebersberger U, Cho YJ, Allmendinger T, Vogt S, Raupach R, Fink C, Saam T, Bamberg F, Nikolaou K, Apfaltrer P. Iterative Image Reconstruction Techniques for CT Coronary Artery Calcium Quantification: Comparison with Traditional Filtered Back Projection in Vitro and in Vivo. Radiology 2014; 270:387-93. [DOI: 10.1148/radiol.13130233] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Saam T, Herzen J, Hetterich H, Fill S, Willner M, Stockmar M, Achterhold K, Zanette I, Weitkamp T, Schüller U, Auweter S, Adam-Neumair S, Nikolaou K, Reiser MF, Pfeiffer F, Bamberg F. Translation of atherosclerotic plaque phase-contrast CT imaging from synchrotron radiation to a conventional lab-based X-ray source. PLoS One 2013; 8:e73513. [PMID: 24039969 PMCID: PMC3767700 DOI: 10.1371/journal.pone.0073513] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/21/2013] [Indexed: 11/26/2022] Open
Abstract
Objectives Phase-contrast imaging is a novel X-ray based technique that provides enhanced soft tissue contrast. The aim of this study was to evaluate the feasibility of visualizing human carotid arteries by grating-based phase-contrast tomography (PC-CT) at two different experimental set-ups: (i) applying synchrotron radiation and (ii) using a conventional X-ray tube. Materials and Methods Five ex-vivo carotid artery specimens were examined with PC-CT either at the European Synchrotron Radiation Facility using a monochromatic X-ray beam (2 specimens; 23 keV; pixel size 5.4 µm), or at a laboratory set-up on a conventional X-ray tube (3 specimens; 35-40 kVp; 70 mA; pixel size 100 µm). Tomographic images were reconstructed and compared to histopathology. Two independent readers determined vessel dimensions and one reader determined signal-to-noise ratios (SNR) between PC-CT and absorption images. Results In total, 51 sections were included in the analysis. Images from both set-ups provided sufficient contrast to differentiate individual vessel layers. All PCI-based measurements strongly predicted but significantly overestimated lumen, intima and vessel wall area for both the synchrotron and the laboratory-based measurements as compared with histology (all p<0.001 with slope >0.53 per mm2, 95%-CI: 0.35 to 0.70). Although synchrotron-based images were characterized by higher SNRs than laboratory-based images; both PC-CT set-ups had superior SNRs compared to corresponding conventional absorption-based images (p<0.001). Inter-reader reproducibility was excellent (ICCs >0.98 and >0.84 for synchrotron and for laboratory-based measurements; respectively). Conclusion Experimental PC-CT of carotid specimens is feasible with both synchrotron and conventional X-ray sources, producing high-resolution images suitable for vessel characterization and atherosclerosis research.
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Affiliation(s)
- Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
- * E-mail:
| | - Julia Herzen
- Chair of Biomedical Physics, Technical University of Munich, Munich, Germany
- Institute of Materials Research, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany
| | - Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sandra Fill
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Marian Willner
- Chair of Biomedical Physics, Technical University of Munich, Munich, Germany
| | - Marco Stockmar
- Chair of Biomedical Physics, Technical University of Munich, Munich, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Technical University of Munich, Munich, Germany
| | - Irene Zanette
- European Synchrotron Radiation Facility (ESRF), Grenoble, France
| | | | - Ulrich Schüller
- Center for Neuropathology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | | | - Konstantin Nikolaou
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Maximilian F. Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Technical University of Munich, Munich, Germany
| | - Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
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Strobl FF, Rominger A, Wolpers S, Rist C, Bamberg F, Thierfelder KM, Nikolaou K, Uebleis C, Hacker M, Reiser MF, Saam T. Impact of cardiovascular risk factors on vessel wall inflammation and calcified plaque burden differs across vascular beds: a PET-CT study. Int J Cardiovasc Imaging 2013; 29:1899-908. [PMID: 23979062 DOI: 10.1007/s10554-013-0277-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 08/12/2013] [Indexed: 01/07/2023]
Abstract
To evaluate the effect of age, gender and cardiovascular risk factors on vessel wall inflammation and the calcified plaque burden in different vascular beds as assessed by PET/CT. 315 patients (mean age: 57.8 years, 123 male and 192 female) who underwent whole body 18F-FDG PET/CT examinations were included in the study. Blood pool-corrected standardised uptake value (TBR) and the calcified plaque score (CPS, grade 0-4) were determined in the thoracic and abdominal aorta, both common carotid and both iliac arteries. The following cardiovascular risk factors were documented: Age ≥65 years (n = 114), male gender (n = 123), diabetes (n = 15), hyperlipidemia (n = 62), hypertension (n = 76), body mass index (BMI) ≥ 30 (n = 38), current smoker (n = 32). Effects of risk factors on TBR and CPS in different arterial beds were assessed using multivariate regression analysis. In the thoracic aorta TBR was independently associated with age ≥65 years and male gender, CPS was independently associated with age ≥65 years, male gender, hypertension and diabetes. In the abdominal aorta, TBR was independently associated with age ≥65 years and male gender, CPS with age ≥65 years, diabetes and smoking. Independent associations in the carotid arteries were found for age ≥65 years, male gender and BMI ≥ 30 in TBR and for age ≥65 and diabetes in CPS. In the iliac arteries, TBR was independently associated with age ≥65 and CPS with age ≥65, male gender, hypertension, diabetes and smoking. Findings of this PET/CT study demonstrate that the impact of cardiovascular risk factors on vessel wall inflammation and calcified plaque burden differs across vascular territories. Overall, CPS was more closely associated with cardiovascular risk factors compared to TBR.
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Affiliation(s)
- Frederik F Strobl
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
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Trelles M, Eberhardt KM, Buchholz M, Schindler A, Bayer-Karpinska A, Dichgans M, Reiser MF, Nikolaou K, Saam T. CTA for screening of complicated atherosclerotic carotid plaque--American Heart Association type VI lesions as defined by MRI. AJNR Am J Neuroradiol 2013; 34:2331-7. [PMID: 23868157 DOI: 10.3174/ajnr.a3607] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution carotid MR imaging can accurately identify complicated American Heart Association lesion type VI plaques, which are characterized by thrombus, hemorrhage, or a ruptured fibrous cap. The purpose of this study is to evaluate whether CTA can be used as screening tool to predict the presence or absence of American Heart Association lesion type VI plaques as defined by high-resolution MR imaging. METHODS Fifty-one patients with suspected ischemic stroke or TIA with carotid CTA and carotid MR imaging performed within 14 days of the event/admission from April 2008 to December 2010 were reviewed. Vessels with stents or occlusion were excluded (n = 2). Each carotid artery was assigned an American Heart Association lesion type classification by MR imaging. The maximum wall thickness, maximum soft plaque component thickness, maximum calcified component thickness, and its attenuation (if the soft plaque component thickness was >2 mm) were obtained from the CTA. RESULTS The maximum soft plaque component thickness proved the best discriminating factor to predict a complicated plaque by MR imaging, with a receiver operating characteristic area under the curve of 0.89. The optimal sensitivity and specificity for detection of complicated plaque by MR imaging was achieved with a soft plaque component thickness threshold of 4.4 mm (sensitivity, 0.65; specificity, 0.94; positive predictive value, 0.75; and negative predictive value, 0.9). No complicated plaque had a soft tissue plaque thickness <2.2 mm (negative predictive value, 1) and no simple (noncomplicated) plaque had a thickness >5.6 mm (positive predictive value, 1). CONCLUSIONS Maximum soft plaque component thickness as measured by carotid CTA is a reliable indicator of a complicated plaque, with a threshold of 2.2 mm representing little to no probability of a complicated American Heart Association lesion type VI plaque.
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Affiliation(s)
- M Trelles
- Department of Radiology, University of Texas Medical Branch, Galveston, Texas
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Saam T, Hetterich H, Hoffmann V, Yuan C, Dichgans M, Poppert H, Koeppel T, Hoffmann U, Reiser MF, Bamberg F. Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging. J Am Coll Cardiol 2013; 62:1081-1091. [PMID: 23850912 DOI: 10.1016/j.jacc.2013.06.015] [Citation(s) in RCA: 222] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/20/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to conduct a systematic review and meta-analysis to determine precise estimates of the predictive value of carotid intraplaque hemorrhage (IPH) as determined by magnetic resonance imaging (MRI) for cerebrovascular events. BACKGROUND There is emerging evidence that MR-based carotid atherosclerotic plaque assessment identifies high-risk features associated with cerebrovascular events. However, available data are based on smaller samples with heterogeneous source populations despite a promising value for noninvasive risk stratification. METHODS We searched PubMed, EMBASE, and the Cochrane Library through September 2012 for studies that followed >35 individuals after baseline MRI. Independent observers abstracted information on populations, MR techniques, outcomes, and study quality. Risk estimates of the presence of IPH for cerebrovascular events were derived in random effects regression analysis, and causes of heterogeneity were determined in meta-regression analysis. RESULTS We identified 8 eligible studies including 689 participants who underwent carotid MRI. The prevalence of IPH at baseline was high (49.0%). Over a median follow-up of 19.6 months, a total of 108 cerebrovascular events occurred (15.7% event rate). The presence of IPH was associated with an ∼6-fold higher risk for events (hazard ratio [HR]: 5.69; 95% confidence interval [CI]: 2.98 to 10.87). The annualized event rate in subjects with detectable IPH was 17.71% compared with 2.43% in patients without IPH. Meta-regression analysis showed symptomatic subjects had higher risks as compared with asymptomatic subjects (HR: 11.71, 95% CI: 5.17 to 26.48 vs. HR: 3.50, 95% CI: 2.59 to 4.73, p = 0.0065), Also, differences were observed for sex and sample size (all p < 0.01), with moderate visual publication bias due to missing smaller sample-size studies (p = 0.18). CONCLUSIONS Presence of IPH on MRI strongly predicts cerebrovascular events. Homogenization of future studies is warranted to allow for sufficient assessment of level of evidence for intervention trials.
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Affiliation(s)
- Tobias Saam
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
| | - Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Verena Hoffmann
- Institute of Biomedical Epidemiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Holger Poppert
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Thomas Koeppel
- Division of Vascular and Endovascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Ulrich Hoffmann
- Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Maximilian F Reiser
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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Coppenrath EM, Lummel N, Linn J, Lenz O, Habs M, Nikolaou K, Reiser MF, Dichgans M, Pfefferkorn T, Saam T. Time-of-flight angiography: a viable alternative to contrast-enhanced MR angiography and fat-suppressed T1w images for the diagnosis of cervical artery dissection? Eur Radiol 2013; 23:2784-92. [DOI: 10.1007/s00330-013-2891-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 03/29/2013] [Accepted: 04/03/2013] [Indexed: 11/29/2022]
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