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Balu N. Editorial for "Quantitative Time-of-Flight Head Magnetic Resonance Angiography of Cerebrovascular Disease". J Magn Reson Imaging 2024. [PMID: 38685865 DOI: 10.1002/jmri.29398] [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] [Received: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Wang D, Naumova A, Isquith D, Sapp J, Huynh KA, Tucker I, Balu N, Voronyuk A, Chu B, Ordovas K, Maynard C, Tian R, Zhao XQ, Kim F. Dapagliflozin Reduces Systemic Inflammation in Patients with Type 2 Diabetes Without Known Heart Failure. Res Sq 2024:rs.3.rs-4132581. [PMID: 38585865 PMCID: PMC10996801 DOI: 10.21203/rs.3.rs-4132581/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Objective Sodium glucose cotransporter 2 (SGLT2) inhibitors significantly improve cardiovascular outcomes in diabetic patients; however, the mechanism is unclear. We hypothesized that dapagliflozin improves cardiac outcomes via beneficial effects on systemic and cardiac inflammation and cardiac fibrosis. Research and Design Methods This randomized placebo-controlled clinical trial enrolled 62 adult patients (mean age 62, 17% female) with type 2 diabetes (T2D) without known heart failure. Subjects were randomized to 12 months of daily 10 mg dapagliflozin or placebo. For all patients, blood/plasma samples and cardiac magnetic resonance imaging (CMRI) were obtained at time of randomization and at the end of 12 months. Systemic inflammation was assessed by plasma IL-1B, TNFα, IL-6 and ketone levels and PBMC mitochondrial respiration, an emerging marker of sterile inflammation. Cardiac fibrosis was assessed by T1 mapping to calculate extracellular volume fraction (ECV); cardiac tissue inflammation was assessed by T2 mapping. Results Between the baseline and 12-month time point, plasma IL-1B was reduced (-1.8 pg/mL, P=0.003) while ketones were increased (0.26 mM, P=0.0001) in patients randomized to dapagliflozin. PBMC maximal oxygen consumption rate (OCR) decreased over the 12-month period in the placebo group but did not change in patients receiving dapagliflozin (-158.9 pmole/min/106cells, P=0.0497 vs -45.2 pmole/min/106cells, P=0.41), a finding consistent with an anti-inflammatory effect of SGLT2i. ECV and T2 relaxation time did not change in both study groups. Conclusion This study demonstrates that 12 months of dapagliflozin reduces IL-1B mediated systemic inflammation but affect cardiac fibrosis in T2D. Clinical Trialgov Registration NCT03782259.
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Balu N, Pipavath S. Editorial for "Non-Contrast-Enhanced Functional Lung MRI to Evaluate Treatment Response of Allergic Bronchopulmonary Aspergillosis in Patients With Cystic Fibrosis: A Pilot Study". J Magn Reson Imaging 2024; 59:920-921. [PMID: 37285083 DOI: 10.1002/jmri.28845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Sudhakar Pipavath
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Chen Z, Liu W, Balu N, Chen L, Ortega D, Huang X, Hatsukami TS, Yang J, Yuan C. Associations of Intracranial Artery Length and Branch Number on Time-of-Flight MRA With Cognitive Impairment in Hypertensive Older Males. J Magn Reson Imaging 2024. [PMID: 38263621 DOI: 10.1002/jmri.29242] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Hypertension-induced impairment of the cerebral artery network contributes to cognitive impairment. Characterizing the structure and function of cerebral arteries may facilitate the understanding of hypertension-related pathological mechanisms and lead to the development of new indicators for cognitive impairment. PURPOSE To investigate the associations between morphological features of the intracranial arteries distal to the circle of Willis on time-of-flight MRA (TOF-MRA) and cognitive performance in a hypertensive cohort. STUDY TYPE Prospective observational study. POPULATION 189 hypertensive older males (mean age 64.9 ± 7.2 years). FIELD STRENGTH/SEQUENCE TOF-MRA sequence with a 3D spoiled gradient echo readout and arterial spin labeling perfusion imaging sequence with a 3D stack-of-spirals fast spin echo readout at 3T. ASSESSMENT The intracranial arteries were segmented from TOF-MRA and the total length of distal arteries (TLoDA) and number of arterial branches (NoB) were calculated. The mean gray matter cerebral blood flow (GM-CBF) was extracted from arterial spin labeling perfusion imaging. The cognitive level was assessed with short-term and long-term delay-recall auditory verbal learning test (AVLT) scores, and with montreal cognitive assessment. STATISTICAL TESTS Univariable and multivariable linear regression were used to analyze the associations between TLoDA, NoB, GM-CBF and the cognitive assessment scores, with P < 0.05 indicating significance. RESULTS TLoDA (r = 0.314) and NoB (r = 0.346) were significantly correlated with GM-CBF. Multivariable linear regression analyses showed that TLoDA and NoB, but not GM-CBF (P = 0.272 and 0.141), were significantly associated with short-term and long-term delay-recall AVLT scores. These associations remained significant after adjusting for GM-CBF. DATA CONCLUSION The TLoDA and NoB of distal intracranial arteries on TOF-MRA are significantly associated with cognitive impairment in hypertensive subjects. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Zhensen Chen
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Wenjin Liu
- Department of Nephrology, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, China
- Yangzhou Institute of Precision Medicine for Kidney Diseases, Yangzhou, China
| | - Niranjan Balu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Dakota Ortega
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Xiaoqin Huang
- Department of Nephrology, The First People's Hospital of Yancheng, Yancheng, China
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chun Yuan
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, Washington, USA
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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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Guo Y, Canton G, Baylam Geleri D, Balu N, Sun J, Kharaji M, Zanaty N, Wang X, Zhang K, L Tirschwell D, Hatsukami TS, Yuan C, Mossa-Basha M. Plaque Evolution and Vessel Wall Remodeling of Intracranial Arteries: A Prospective, Longitudinal Vessel Wall MRI Study. J Magn Reson Imaging 2023. [PMID: 38131254 DOI: 10.1002/jmri.29185] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Progression of intracranial atherosclerotic disease (ICAD) is associated with ischemic stroke events and can be quantified with three-dimensional (3D) intracranial vessel wall (IVW) MRI. However, longitudinal 3D IVW studies are limited and ICAD evolution remains relatively unknown. PURPOSE To evaluate ICAD changes longitudinally and to characterize the imaging patterns of atherosclerotic plaque evolution. STUDY TYPE Prospective. POPULATION 37 patients (69 ± 12 years old, 12 females) with angiography confirmed ICAD. FIELD STRENGTH/SEQUENCE 3.0T/3D time-of-flight gradient echo sequence and T1- and proton density-weighted fast spin echo sequences. ASSESSMENT Each patient underwent baseline and 1-year follow-up IVW. Then, IVW data from both time points were jointly preprocessed using a multitime point, multicontrast, and multiplanar viewing workflow (known as MOCHA). Lumen and outer wall of plaques were traced and measured, and plaques were then categorized into progression, stable, and regression groups based on changes in plaque wall thickness. Patient demographic and clinical data were collected. Culprit plaques were identified based on cerebral ischemic infarcts. STATISTICAL TESTS Generalized estimating equations-based linear and logistic regressions were used to assess associations between vascular risk factors, medications, luminal stenosis, IVW plaque imaging features, and longitudinal changes. A two-sided P-value<0.05 was considered statistically significant. RESULTS Diabetes was significantly associated with ICAD progression, resulting in 6.6% decrease in lumen area and 6.7% increase in wall thickness at 1-year follow-up. After accounting for arterial segments, baseline contrast enhancement predicted plaque progression (odds ratio = 3.61). Culprit plaques experienced an average luminal expansion of 10.9% after 1 year. 74% of the plaques remained stable during follow-up. The regression group (18 plaques) showed significant increase in minimum lumen area (from 7.4 to 8.3 mm2 ), while the progression group (13 plaques) showed significant decrease in minimum lumen area (from 5.4 to 4.3 mm2 ). DATA CONCLUSION Longitudinal 3D IVW showed ICAD remodeling on the lumen side. Culprit plaques demonstrated longitudinal luminal expansion compared with their non-culprit counterparts. Baseline plaque contrast enhancement and diabetes mellitus were found to be significantly associated with ICAD changes. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Yin Guo
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Gador Canton
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Duygu Baylam Geleri
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jie Sun
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mona Kharaji
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nadin Zanaty
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Radiology, Zagazig University, Zagazig, Egypt
| | - Xin Wang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Kaiyu Zhang
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - David L Tirschwell
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Radiology and Imaging Science, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, USA
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Leotta DF, Ly D, Galil B, Thiel J, Willis E, Balu N, Liu ZJ. Tissue properties and respiratory kinematics of the tongue base and soft palate in the obese OSA minipig. PLoS One 2023; 18:e0293907. [PMID: 38060522 PMCID: PMC10703339 DOI: 10.1371/journal.pone.0293907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/22/2023] [Indexed: 12/18/2023] Open
Abstract
Obesity is a common finding and a major pathogenetic factor in obstructive sleep apnea (OSA) in adults. To understand the mechanisms behind this, the present study investigated the tissue properties and respiratory kinematics of the tongue base and soft palate in the obese OSA minipig model. In 4 verified obese/OSA and 3 non-obese/non-OSA control minipigs, MRI fat-weighted images, ultrasound elastography (USE), and sleep video-fluoroscopy (SVF) were performed to quantify the fat composition, tissue stiffness, and respiratory kinematics of the tongue base and soft palate during sedated sleep. The results indicated that the fat composition gradually increased from the rostral to caudal tongue base, particularly in the posterior 1/3 of the tongue base, regardless of the presence of obesity and OSA. However, this trend was not seen in the soft palate and pharyngeal wall. The pharyngeal wall presented the highest fat composition as compared with the tongue base and soft palate. Overall, obese OSA minipigs showed stiffer tongue tissue than the controls, particularly in the rostral region of the tongue in obese Yucatan minipigs. The respiratory moving ranges of the soft palate were greater in both dorsal-ventral and rostral-caudal directions and during both respiratory and expiratory phases in OSA obese than control minipigs, and the largest moving ranges were seen in OSA obese Panepinto minipigs. The moving range of the tongue base was significantly smaller. These results suggest more fat infiltration in the caudal region of the tongue base regardless of the presence of obesity and/or OSA. The greater tissue stiffness of the tongue in obese OSA minipigs may result from altered neuromuscular drive.
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Affiliation(s)
- Daniel F. Leotta
- Center for Industrial and Medical Ultrasound/Applied Physics Laboratory, University of Washington, Seattle, WA, United States of America
| | - Daniel Ly
- Dept. Orthodontics, School of Dentistry, University of Washington, Seattle, WA, United States of America
| | - Bishoy Galil
- Dept. Orthodontics, School of Dentistry, University of Washington, Seattle, WA, United States of America
| | - Jeff Thiel
- Center for Industrial and Medical Ultrasound/Applied Physics Laboratory, University of Washington, Seattle, WA, United States of America
| | - Elliot Willis
- Dept. Orthodontics, School of Dentistry, University of Washington, Seattle, WA, United States of America
| | - Niranjan Balu
- Dept. Radiology, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Zi-Jun Liu
- Dept. Orthodontics, School of Dentistry, University of Washington, Seattle, WA, United States of America
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Sui B, Sannananja B, Zhu C, Balu N, Eisenmenger L, Baradaran H, Edjlali M, Romero JM, Rajiah PS, Li R, Mossa-Basha M. Report from the society of magnetic resonance angiography: clinical applications of 7T neurovascular MR in the assessment of intracranial vascular disease. J Neurointerv Surg 2023:jnis-2023-020668. [PMID: 37652689 PMCID: PMC10902184 DOI: 10.1136/jnis-2023-020668] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Abstract
In recent years, ultra-high-field magnetic resonance imaging (MRI) applications have been rapidly increasing in both clinical research and practice. Indeed, 7-Tesla (7T) MRI allows improved depiction of smaller structures with high signal-to-noise ratio, and, therefore, may improve lesion visualization, diagnostic capabilities, and thus potentially affect treatment decision-making. Incremental evidence emerging from research over the past two decades has provided a promising prospect of 7T magnetic resonance angiography (MRA) in the evaluation of intracranial vasculature. The ultra-high resolution and excellent image quality of 7T MRA allow us to explore detailed morphological and hemodynamic information, detect subtle pathological changes in early stages, and provide new insights allowing for deeper understanding of pathological mechanisms of various cerebrovascular diseases. However, along with the benefits of ultra-high field strength, some challenges and concerns exist. Despite these, ongoing technical developments and clinical oriented research will facilitate the widespread clinical application of 7T MRA in the near future. In this review article, we summarize technical aspects, clinical applications, and recent advances of 7T MRA in the evaluation of intracranial vascular disease. The aim of this review is to provide a clinical perspective for the potential application of 7T MRA for the assessment of intracranial vascular disease, and to explore possible future research directions implementing this technique.
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Affiliation(s)
- Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bhagya Sannananja
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Vascular Imaging Lab, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Hediyeh Baradaran
- Department of Radiology & Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Javier M Romero
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rui Li
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, USA
- Vascular Imaging Lab, University of Washington School of Medicine, Seattle, Washington, USA
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Zhang K, Chen Z, Chen L, Canton G, Geleri DB, Chu B, Guo Y, Hippe DS, Pimentel KD, Balu N, Hatsukami TS, Yuan C. Alterations in cerebral distal vascular features and effect on cognition in a high cardiovascular risk population: A prospective longitudinal study. Magn Reson Imaging 2023; 98:36-43. [PMID: 36567002 PMCID: PMC9924304 DOI: 10.1016/j.mri.2022.12.011] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Alterations in cerebral vasculature are instrumental in affecting cognition. Current studies mainly focus on proximal large arteries and small vessels, while disregarding morphology and blood flow of the arteries between them (medium-to-large arteries). METHODS In this prospective study, two types of non-contrast enhanced magnetic resonance angiography (NCE-MRA) techniques, simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) and 3D Time-of-flight (TOF), were used to measure vascular morphologic features in medium-to-large intracranial arteries. Grey matter (GM) tissue level perfusion was assessed with arterial spin labeling (ASL) MRI. Twenty-seven subjects at high cardiovascular risk underwent baseline and 12-month follow-up MRI to compare the relationship between morphological features measured by NCE MRA, GM CBF by ASL MRI, and cognitive function measured by the Montreal Cognitive Assessment (MoCA). RESULTS Changes in both global medium-to-large arteries and posterior cerebral (PCA) distal artery length and branch numbers, measured on SNAP MRA, were significantly associated with alterations in MoCA scores (P < 0.01), after adjusting for clinical confounding factors, total brain volume, and total white matter lesion (WML) volume. There were no associations between MoCA scores and vascular features on TOF MRA or ASL GM CBF. CONCLUSIONS Alterations in vascular features of distal medium-to-large arteries may be more sensitive for detecting potential changes in cognition than cerebral blood flow alterations at the parenchymal level captured by perfusion ASL. Hemodynamic information from distal medium-to-large arteries provides an additional tool to advance understanding of the vascular contributions to cognitive function.
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Affiliation(s)
- Kaiyu Zhang
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Zhensen Chen
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States of America
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, WA, United States of America
| | - Duygu Baylam Geleri
- Department of Radiology, University of Washington, Seattle, WA, United States of America
| | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA, United States of America
| | - Yin Guo
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, United States of America
| | - Kristi D Pimentel
- Department of Radiology, University of Washington, Seattle, WA, United States of America
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, United States of America
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, WA, United States of America
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America; Department of Radiology, University of Washington, Seattle, WA, United States of America.
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10
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Shirakawa M, Yamada K, Watase H, Chu B, Enomoto Y, Kojima T, Wakabayashi K, Sun J, Hippe DS, Ferguson MS, Balu N, Yoshimura S, Hatsukami TS, Yuan C. Atherosclerotic carotid plaque characteristics vary with time from ischemic event: A multicenter, prospective magnetic resonance vessel wall imaging registry study. J Neurol Sci 2023; 446:120582. [PMID: 36796273 DOI: 10.1016/j.jns.2023.120582] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/12/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
Recent studies report that the rate of recurrent stroke is highest in the stages immediately following cerebral infarction and decreases over time in patients with atherosclerotic carotid stenosis. The purpose of this study was to identify temporal differences in early stage carotid plaque components from acute cerebrovascular ischemic events using carotid MRI. Carotid plaque images were obtained on 3 T MRI from 128 patients enrolled in MR-CAS. Among the 128 subjects, 53 were symptomatic and 75 asymptomatic. The symptomatic patients were classified into three groups based on interval from onset of symptoms to the date of the carotid MRI (Group <14 days; 15-30 days; and > 30 days). The volume of each plaque component was identified and quantified from MR images. The presence of juxtaluminal loose matrix/inflammation (LM/I) was identified as a possible indicator of inflammation on the luminal side. Plaque components were compared between groups using the Wilcoxon rank-sum or the Chi-square test. Patient characteristics and carotid plaque morphology were similar among all four groups. The median volume of LM/I in Group >30 days was significantly lower than in other groups (0 mm3 vs 12.3 mm3 and 18.1 mm3; p = 0.003). In addition, the prevalence of juxtaluminal LM/I decreased over time (ptrend = 0.002). There were no statistically significant differences in other plaque components between the symptomatic groups. The volume of LM/I was significantly smaller in Group >30 days and prevalence of juxtaluminal LM/I in the atherosclerotic carotid plaque was high in the early stages after events. This suggests that carotid plaques undergo rapid evolution after an acute cerebrovascular ischemic event.
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Affiliation(s)
- Manabu Shirakawa
- Department of Radiology, University of Washington, Seattle, USA; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Hiroko Watase
- Department of Emergency and General Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, USA
| | - Yukiko Enomoto
- Department of Neurosurgery, Gifu University, Gifu, Japan
| | - Takao Kojima
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | | | - Jie Sun
- Department of Radiology, University of Washington, Seattle, USA
| | - Daniel S Hippe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, USA
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Thomas S Hatsukami
- Department of Surgery, Division of Vascular Surgery, University of Washington, Seattle, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, USA.
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11
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Mossa-Basha M, Yuan C, Wasserman BA, Mikulis DJ, Hatsukami TS, Balu N, Gupta A, Zhu C, Saba L, Li D, DeMarco JK, Lehman VT, Qiao Y, Jager HR, Wintermark M, Brinjikji W, Hess CP, Saloner DA. Survey of the American Society of Neuroradiology Membership on the Use and Value of Extracranial Carotid Vessel Wall MRI. AJNR Am J Neuroradiol 2022; 43:1756-1761. [PMID: 36423951 DOI: 10.3174/ajnr.a7720] [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] [Received: 06/22/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Extracranial vessel wall MRI (EC-VWI) contributes to vasculopathy characterization. This survey study investigated EC-VWI adoption by American Society of Neuroradiology (ASNR) members and indications and barriers to implementation. MATERIALS AND METHODS The ASNR Vessel Wall Imaging Study Group survey on EC-VWI use, frequency, applications, MR imaging systems and field strength used, protocol development approaches, vendor engagement, reasons for not using EC-VWI, ordering provider interest, and impact on clinical care was distributed to the ASNR membership between April 2, 2019, to August 30, 2019. RESULTS There were 532 responses; 79 were excluded due to minimal, incomplete response and 42 due to redundant institutional responses, leaving 411 responses. Twenty-six percent indicated that their institution performed EC-VWI, with 66.3% performing it ≤1-2 times per month, most frequently on 3T MR imaging, with most using combined 3D and 2D protocols. Protocols most commonly included pre- and postcontrast T1-weighted imaging, TOF-MRA, and contrast-enhanced MRA. Inflammatory vasculopathy (63.3%), plaque vulnerability assessments (61.1%), intraplaque hemorrhage (61.1%), and dissection-detection/characterization (51.1%) were the most frequent applications. For those not performing EC-VWI, the reasons were a lack of ordering provider interest (63.9%), lack of radiologist time/interest (47.5%) or technical support (41.4%) for protocol development, and limited interpretation experience (44.9%) and knowledge of clinical applications (43.7%). Reasons given by 46.9% were that no providers approached radiology with interest in EC-VWI. If barriers were overcome, 51.1% of those not performing EC-VWI indicated they would perform it, and 40.6% were unsure; 48.6% did not think that EC-VWI had impacted patient management at their institution. CONCLUSIONS Only 26% of neuroradiology groups performed EC-VWI, most commonly due to limited clinician interest. Improved provider and radiologist education, protocols, processing techniques, technical support, and validation trials could increase adoption.
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Affiliation(s)
- M Mossa-Basha
- From the Department of Radiology (M.M.-B.), University of North Carolina, Chapel Hill, North Carolina .,Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - C Yuan
- Department of Radiology (C.Y.), University of Utah, Salt Lake City, Utah
| | - B A Wasserman
- Department of Radiology (B.A.W.), University of Maryland, Baltimore, Maryland.,Department of Radiology (B.A.W., Y.Q.), Johns Hopkins University, Baltimore, Maryland
| | - D J Mikulis
- Joint Department of Medical Imaging (D.J.M.), The University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - A Gupta
- Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - C Zhu
- Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - L Saba
- Department of Radiology (L.S.), University of Cagliari, Cagliari, Sardinia, Italy
| | - D Li
- Biomedical Imaging Research Institute (D.L.), Cedars-Sinai Medical Center, Los Angeles, California
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - V T Lehman
- Department of Radiology (V.T.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - Y Qiao
- Department of Radiology (B.A.W., Y.Q.), Johns Hopkins University, Baltimore, Maryland
| | - H R Jager
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London, Queen Square Institute of Neurology, London, UK
| | - M Wintermark
- Department of Neuroradiology (M.W.), MD Anderson Cancer Institute, Houston, Texas
| | - W Brinjikji
- Department of Radiology (V.T.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - C P Hess
- Department of Radiology and Biomedical Imaging (C.P.H., D.A.S.), University of California, San Francisco, San Francisco, California
| | - D A Saloner
- Department of Radiology and Biomedical Imaging (C.P.H., D.A.S.), University of California, San Francisco, San Francisco, California
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12
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Zhao XQ, Sun J, Hippe DS, Isquith DA, Canton G, Yamada K, Balu N, Crouse JR, Anderson TJ, Huston J, O’Brien KD, Hatsukami TS, Yuan C. Magnetic Resonance Imaging of Intraplaque Hemorrhage and Plaque Lipid Content With Continued Lipid-Lowering Therapy: Results of a Magnetic Resonance Imaging Substudy in AIM-HIGH. Circ Cardiovasc Imaging 2022; 15:e014229. [PMID: 36378778 PMCID: PMC9773914 DOI: 10.1161/circimaging.122.014229] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intraplaque hemorrhage (IPH) is associated with plaque progression and ischemic events, and plaque lipid content (% lipid core) predicts the residual atherosclerotic cardiovascular disease risk. This study examined the impact of IPH on lipid content change in the setting of intensive lipid-lowering therapy. METHODS In total, 214 AIM-HIGH (Atherothrombosis Intervention in Metabolic Syndrome with Low High-Density Lipoprotein/High Triglycerides: Impact on Global Health Outcomes) participants with clinically established ASCVD and low high-density lipoprotein cholesterol received cartoid MRI at baseline and 2 years to assess changes in carotid morphology and composition. Patients were randomized to extended-release niacin or placebo, and all received simvastatin with optional ezetimibe as necessary to lower low-density lipoprotein cholesterol to 40 to 80 mg/dL. Changes in lipid content and carotid morphology were tested using the Wilcoxon signed-rank test. Differences between subjects with and without IPH and between subjects assigned extended-release niacin or placebo were tested using the Wilcoxon rank-sum test. Linear regression was used to test the association of IPH and lipid content changes after adjusting for clinical risk factors. RESULTS Among 156 patients (61±9 years; 81% men) with complete MRI, prior statin use: <1 year, 26%; 1 to 5 years, 37%; >5 years, 37%. Triglycerides and ApoB decreased significantly, whereas high-density lipoprotein cholesterol and ApoA1 increased significantly over time. Plaque lipid content was significantly reduced (-0.5±2.4 %/year, P = 0.017) without a significant difference between the 2 treatment groups. However, the lipid content increased in plaques with IPH but regressed in plaques without IPH (1.2±2.5 %/year versus -1.0±2.2, P = 0.006). Additionally, IPH was associated with a decrease in lumen area (-0.4±0.9 mm2/year versus 0.3±1.4, P = 0.033). IPH remained significantly associated with increase in lipid content in multivariable analysis (54.4%, 95% CI: 26.8, 88.0, P < 0.001). CONCLUSIONS Carotid plaques under continued intensive lipid-lowering therapy moved toward stabilization. However, plaques with IPH showed greater increases in lipid content and greater decreases in lumen area than plaques without IPH. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01178320.
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Affiliation(s)
- Xue-Qiao Zhao
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel A. Isquith
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington
| | - Kiyofumi Yamada
- Department of Radiology, University of Washington, Seattle, Washington
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | - John R. Crouse
- Department of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Todd J. Anderson
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Kevin D. O’Brien
- Department of Medicine (Division of Cardiology), University of Washington, Seattle, Washington
| | - Thomas S. Hatsukami
- Department of Surgery (Division of Vascular Surgery), University of Washington, Seattle, Washington
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington
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13
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Sun J, Mossa-Basha M, Canton G, Balu N, Guo Y, Chen L, Xu D, Hippe DS, Pimentel KD, Hatsukami TS, Yuan C. Characterization of non-stenotic plaques in intracranial arteries with multi-contrast, multi-planar vessel wall image analysis. J Stroke Cerebrovasc Dis 2022; 31:106719. [PMID: 35994880 PMCID: PMC9509474 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Non-stenotic plaques have been observed in intracranial arteries but are less understood compared to those in coronary and carotid arteries. We sought to compare plaque distribution and morphology between stenotic and non-stenotic intracranial plaques with MR vessel wall imaging (VWI) and quantitative image analysis. MATERIALS AND METHODS Twenty-four patients with intracranial arterial stenosis or luminal irregularity on clinical imaging were scanned with a multi-contrast VWI protocol. Plaques were detected as focal wall thickening on co-registered multiplanar reformats of multi-contrast VWI, with assessment of the location and morphology. TOF-MRA was independently reviewed for any appreciable stenosis using the WAISD criteria. RESULTS Across 504 arterial segments, a total of 80 plaques were detected, including 23 (29%) with stenosis on TOF-MRA, 56 (70%) without, and 1 (1%) not covered by TOF-MRA. Plaques involving the ICA were more likely to be non-stenotic than those involving other segments (80% versus 55%, p = 0.030) whereas the basilar artery (40%) and PCA (33%) had the lowest proportions of non-stenotic plaques. Maximum wall thickness, indicative of plaque burden, correlated poorly with degree of stenosis (p = 0.10) and overlapped substantially between stenotic and non-stenotic plaques (1.9 [1.5, 2.4] versus 2.0 [1.5, 2.2] mm, p = 0.074). CONCLUSIONS Intracranial plaques without appreciable stenosis on TOF-MRA represent a large proportion of lesions throughout arterial segments but disproportionately affect the ICA. Morphological characterization of plaques with and without stenosis shows that luminal stenosis is a poor indicator of the underlying burden of intracranial atherosclerosis.
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Affiliation(s)
- Jie Sun
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States.
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | - Gador Canton
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | - Niranjan Balu
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | - Yin Guo
- Department of Bioengineering, University of Washington, United States
| | - Li Chen
- Department of Bioengineering, University of Washington, United States
| | - Dongxiang Xu
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | - Daniel S Hippe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, United States
| | - Kristi D Pimentel
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States
| | | | - Chun Yuan
- Department of Radiology, University of Washington, 850 Republican St, Seattle, WA 98109, United States; Department of Bioengineering, University of Washington, United States
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14
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Liu J, Wang C, Wang J, Zhang C, Wu Y, Balu N, Qi H, Zhang Q, Yuan C, Chen H. Motion detection and correction for carotid MRI using a markerless optical system. Magn Reson Imaging 2022; 94:161-167. [PMID: 36191857 DOI: 10.1016/j.mri.2022.09.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 04/29/2022] [Accepted: 09/27/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Motion related artifact is a challenge for MRI, especially when imaging regions like the carotid artery where complex motion (abrupt and bulk motion) may occur. This study aims to develop a non-contact motion detection and correction system for carotid MRI using a markerless optical tracking system. METHODS The proposed markerless optical tracking system consisted of a cross-line laser, an MRI-compatible camera and plastic holders mounted inside the scanner bore. The neck motion of the subject can be captured by monitoring the change of the projected laser position in real-time. The system was used to correct both abrupt motion and bulk motion for carotid MRI. The abrupt motion (e.g. coughing) was compensated by discarding the corrupted k-space lines and re-estimating the missing lines using SPIRiT algorithm. The bulk motion was corrected by phase adjustment of k-space lines according to the measured 1D-translational bulk motion (along anterior-posterior direction) and optimized in-plane translation parameters. Ten volunteers underwent carotid MRI with real-time neck motion detection and retrospective motion correction. Artery sharpness, vessel wall thickness and overall image quality score were compared between the motion-corrupted image and motion-corrected images of different correction strategies. RESULTS Both the abrupt motion and the bulk motion during carotid scanning were successfully detected and corrected. The results of ten volunteers demonstrated significant improvement in carotid artery sharpness, vessel wall thickness measurement, and overall image quality score using the proposed markerless optical tracking system and motion correction strategies. CONCLUSION The proposed markerless structured light based motion detection and correction system can sensitively detect both abrupt and bulk motion during carotid MR scans. By correcting for both abrupt and bulk motion, vessel wall delineation was improved in carotid MR images, which could potentially facilitate carotid plaque identification and atherosclerosis diagnosis in the future.
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Affiliation(s)
- Jin Liu
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Chunyao Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jinnan Wang
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America.
| | - Chen Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yifan Wu
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America
| | - Niranjan Balu
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America.
| | - Haikun Qi
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, WA, United States of America.
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
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15
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Saba L, Antignani PL, Gupta A, Cau R, Paraskevas KI, Poredos P, Wasserman B, Kamel H, Avgerinos ED, Salgado R, Caobelli F, Aluigi L, Savastano L, Brown M, Hatsukami T, Hussein E, Suri JS, Mansilha A, Wintermark M, Staub D, Montequin JF, Rodriguez RTT, Balu N, Pitha J, Kooi ME, Lal BK, Spence JD, Lanzino G, Marcus HS, Mancini M, Chaturvedi S, Blinc A. International Union of Angiology (IUA) consensus paper on imaging strategies in atherosclerotic carotid artery imaging: From basic strategies to advanced approaches. Atherosclerosis 2022; 354:23-40. [DOI: 10.1016/j.atherosclerosis.2022.06.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
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16
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Chen Z, Gould A, Geleri DB, Balu N, Chen L, Chu B, Pimentel K, Canton G, Hatsukami TS, Yuan C. Associations of intracranial artery length and branch number on non-contrast enhanced MRA with cognitive impairment in individuals with carotid atherosclerosis. Sci Rep 2022; 12:7456. [PMID: 35524158 PMCID: PMC9076596 DOI: 10.1038/s41598-022-11418-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/20/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Developing novel risk markers for vascular contributions to cognitive impairment and dementia is important. This study aimed to extract total length, branch number and average tortuosity of intracranial distal arteries (A2, M2, P2 and more distal) from non-contrast enhanced magnetic resonance angiography (NCE-MRA) images, and explore their associations with global cognition. In 29 subjects (aged 40-90 years) with carotid atherosclerotic disease, the 3 intracranial vascular features on two NCE-MRA techniques (i.e. time of flight, TOF and simultaneous non-contrast angiography and intraplaque hemorrhage, SNAP) were extracted using a custom-developed software named iCafe. Arterial spin labeling (ASL) and phase contrast (PC) cerebral blood flow (CBF) were measured as references. Linear regression was performed to study their associations with global cognition, measured with the Montreal Cognitive Assessment (MoCA). Intracranial artery length and number of branches on NCE-MRA, ASL CBF and PC CBF were found to be positively associated with MoCA scores (P < 0.01). The associations remained significant for artery length and number of branches on NCE-MRA after adjusting for clinical covariates and white matter hyperintensity volume. Further adjustment of confounding factors of ASL CBF or PC CBF did not abolish the significant association for artery length and number of branches on TOF. Our findings suggest that intracranial vascular features, including artery length and number of branches, on NCE-MRA may be useful markers of cerebrovascular health and provide added information over conventional brain blood flow measurements in individuals with cognitive impairment.
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Affiliation(s)
- Zhensen Chen
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA.
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA.
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
| | - Anders Gould
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Duygu Baylam Geleri
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
| | - Niranjan Balu
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
| | - Baocheng Chu
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Kristi Pimentel
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
| | - Gador Canton
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
| | | | - Chun Yuan
- Vascular Imaging Laboratory, Department of Radiology, University of Washington, 850 Republican Street, Box 358050, Seattle, WA, 98109, USA
- BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, USA
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17
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Guo Y, Canton G, Chen L, Sun J, Geleri DB, Balu N, Xu D, Mossa-Basha M, Hatsukami TS, Yuan C. Multi-Planar, Multi-Contrast and Multi-Time Point Analysis Tool (MOCHA) for Intracranial Vessel Wall Characterization. J Magn Reson Imaging 2022; 56:944-955. [PMID: 35099091 DOI: 10.1002/jmri.28087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) intracranial vessel wall (IVW) magnetic resonance imaging can reliably image intracranial atherosclerotic disease (ICAD). However, an integrated, streamlined, and optimized workflow for IVW analysis to provide qualitative and quantitative measurements is lacking. PURPOSE To propose and evaluate an image analysis pipeline (MOCHA) that can register multicontrast and multitime point 3D IVW for multiplanar review and quantitative plaque characterization. STUDY TYPE Retrospective. POPULATION A total of 11 subjects with ICAD (68 ± 10 years old, 6 males). FIELD STRENGTH/SEQUENCE A 3.0 T, 3D time-of-flight gradient echo sequence and T1- and proton density-weighted fast spin echo sequences. ASSESSMENT Each participant underwent two IVW sessions within 2 weeks. Scan and rescan IVW images were preprocessed using MOCHA. The presence of atherosclerotic lesions was identified in different intracranial arterial segments by two readers (GC and JS, 12 years of vascular MR imaging experience each) following an established review protocol to reach consensus on each of the reviews. For all locations with identified plaques, plaque length, lumen and vessel wall areas, maximum and mean wall thickness values, normalized wall index and contrast enhancement ratio were measured. STATISTICAL TESTS Percent agreement and Cohen's κ were used to test scan-rescan reproducibility of detecting plaques using MOCHA. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to evaluate scan-rescan reproducibility for plaque morphologic and enhancement measurements. RESULTS In 150 paired intracranial vessel segments, the overall agreement in plaque detection was 92.7% (κ = 0.822). The ICCs (all ICCs > 0.90) and Bland-Altman plots (no bias observed) indicated excellent scan-rescan reproducibility for all morphologic and enhancement measurements. DATA CONCLUSION Findings from this study demonstrate that MOCHA provides high scan-rescan reproducibility for identification and quantification of atherosclerosis along multiple intracranial arterial segments and highlight its potential use in characterizing plaque composition and monitoring plaque development. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yin Guo
- Department of Bioengineering, University of Washington, Seattle, Washington, 98109, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, 98109, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Duygu Baylam Geleri
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, 98109, USA
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, Washington, 98109, USA.,Department of Radiology, University of Washington, Seattle, Washington, 98109, USA
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18
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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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19
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Lepor NE, Sun J, Canton G, Contreras L, Hippe DS, Isquith DA, Balu N, Kedan I, Simonini AA, Yuan C, Hatsukami TS, Zhao XQ. Regression in carotid plaque lipid content and neovasculature with PCSK9 inhibition: A time course study. Atherosclerosis 2021; 327:31-38. [PMID: 34038761 DOI: 10.1016/j.atherosclerosis.2021.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce cardiovascular events, but their effects on atherosclerotic plaque remain elusive. Using serial magnetic resonance imaging (MRI), we studied changes in carotid plaque lipid content and neovasculature under PCSK9 inhibition with alirocumab. METHODS Among patients with low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dl but ineligible for high-dose statin therapy, those with lipid core on carotid MRI were identified to receive alirocumab 150 mg every 2 weeks. Follow-up MRI was performed at 3, 6, and 12 months after treatment. Pre- and post-contrast MRI were acquired to measure percent lipid core volume (% lipid core). Dynamic contrast-enhanced MRI was acquired to measure the extravasation rate of gadolinium contrast (Ktrans), a marker of plaque neovasculature. RESULTS Of 31 patients enrolled, 27 completed the study (mean age: 69 ± 9; male: 67%). From 9.8% at baseline, % lipid core was progressively reduced to 8.4% at 3 months, 7.5% at 6 months, and 7.2% at 12 months (p = 0.014 for trend), which was accompanied by a progressive increase in % fibrous tissue (p = 0.009) but not % calcification (p = 0.35). Ktrans was not reduced until 12 months (from 0.069 ± 0.019 min-1 to 0.058 ± 0.020 min-1; p = 0.029). Lumen and wall areas did not change significantly during the study period. CONCLUSIONS Regression in plaque composition and neovasculature were observed under PCSK9 inhibition on carotid MRI, which provides unique insight into the biological process of plaque stabilization with disease-modifying therapies.
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Affiliation(s)
- Norman E Lepor
- Westside Medical Associates of Los Angeles, Beverly Hills, CA, USA; Smidt Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Jie Sun
- University of Washington, Seattle, WA, USA.
| | | | - Laurn Contreras
- Westside Medical Associates of Los Angeles, Beverly Hills, CA, USA
| | | | | | | | - Ilan Kedan
- Smidt Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | | | - Chun Yuan
- University of Washington, Seattle, WA, USA
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20
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Canton G, Hippe DS, Chen L, Waterton JC, Liu W, Watase H, Balu N, Sun J, Hatsukami TS, Yuan C. Atherosclerotic Burden and Remodeling Patterns of the Popliteal Artery as Detected in the Magnetic Resonance Imaging Osteoarthritis Initiative Data Set. J Am Heart Assoc 2021; 10:e018408. [PMID: 33998279 PMCID: PMC8483503 DOI: 10.1161/jaha.120.018408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background An artificial intelligence vessel segmentation tool, Fully Automated and Robust Analysis Technique for Popliteal Artery Evaluation (FRAPPE), was used to analyze a large databank of popliteal arteries imaged through the OAI (Osteoarthritis Initiative) to study the impact of atherosclerosis risk factors on vessel dimensions and characterize remodeling patterns. Methods and Results Magnetic resonance images from 4668 subjects contributing 9189 popliteal arteries were analyzed using FRAPPE. Age ranged from 45 to 79 years (median, 61), and 58% were women. Mean lumen diameter, mean outer wall diameter, and mean wall thickness (MWT) were measured per artery. Their median values were 5.8 mm (interquartile range, 5.2–6.5 mm), 7.3 mm (interquartile range, 6.7–8.1 mm), and 0.78 mm (interquartile range, 0.73–0.84 mm) respectively. MWT was associated with multiple cardiovascular risk factors, with age (4.2% increase in MWT per 10‐year increase in age; 95% CI, 3.9%–4.5%) and sex (8.6% higher MWT in men than women; 95% CI, 7.7%–9.3%) being predominant. On average, lumen and outer wall diameters increased with increasing MWT until the thickness was 0.92 mm for men and 0.84 mm for women. After this point, lumen diameter decreased steadily, more rapidly in men than women (−7.9% versus −6.1% per 25% increase in MWT; P<0.001), with little change in outer wall diameter. Conclusions FRAPPE has enabled the analysis of the large OAI knee magnetic resonance imaging data set, successfully showing that popliteal atherosclerosis is predominantly associated with age and sex. The average vessel remodeling pattern consisted of an early phase of compensatory enlargement, followed by a negative remodeling, which is more pronounced in men.
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Affiliation(s)
- Gador Canton
- Department of RadiologyUniversity of WashingtonSeattleWA
| | | | - Li Chen
- Department of Electrical and Computer EngineeringUniversity of WashingtonSeattleWA
| | - John C. Waterton
- Centre for Imaging SciencesManchester Academic Health Science CentreThe University of ManchesterUnited Kingdom
| | - Wenjin Liu
- Department of RadiologyUniversity of WashingtonSeattleWA
| | - Hiroko Watase
- Department of SurgeryUniversity of WashingtonSeattleWA
| | - Niranjan Balu
- Department of RadiologyUniversity of WashingtonSeattleWA
| | - Jie Sun
- Department of RadiologyUniversity of WashingtonSeattleWA
| | | | - Chun Yuan
- Department of RadiologyUniversity of WashingtonSeattleWA
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21
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Balu N, Ordovas KG. Editorial for "Myocardial T1 Values at 1.5 T: Normal Values for General Electric Scanners and Sex-Related Differences". J Magn Reson Imaging 2021; 54:1501-1502. [PMID: 33949735 DOI: 10.1002/jmri.27675] [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] [Received: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Karen G Ordovas
- Department of Radiology, University of Washington, Seattle, Washington, USA
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22
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Chen L, Zhao H, Jiang H, Balu N, Geleri DB, Chu B, Watase H, Zhao X, Li R, Xu J, Hatsukami TS, Xu D, Hwang JN, Yuan C. Domain adaptive and fully automated carotid artery atherosclerotic lesion detection using an artificial intelligence approach (LATTE) on 3D MRI. Magn Reson Med 2021; 86:1662-1673. [PMID: 33885165 DOI: 10.1002/mrm.28794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/14/2021] [Revised: 03/07/2021] [Accepted: 03/18/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To develop and evaluate a domain adaptive and fully automated review workflow (lesion assessment through tracklet evaluation, LATTE) for assessment of atherosclerotic disease in 3D carotid MR vessel wall imaging (MR VWI). METHODS VWI of 279 subjects with carotid atherosclerosis were used to develop LATTE, mainly convolutional neural network (CNN)-based domain adaptive lesion classification after image quality assessment and artery of interest localization. Heterogeneity in test sets from various sites usually causes inferior CNN performance. With our novel unsupervised domain adaptation (DA), LATTE was designed to accurately classify arteries into normal arteries and early and advanced lesions without additional annotations on new datasets. VWI of 271 subjects from four datasets (eight sites) with slightly different imaging parameters/signal patterns were collected to assess the effectiveness of DA of LATTE using the area under the receiver operating characteristic curve (AUC) on all lesions and advanced lesions before and after DA. RESULTS LATTE had good performance with advanced/all lesion classification, with the AUC of >0.88/0.83, significant improvements from >0.82/0.80 if without DA. CONCLUSIONS LATTE can locate target arteries and distinguish carotid atherosclerotic lesions with consistently improved performance with DA on new datasets. It may be useful for carotid atherosclerosis detection and assessment on various clinical sites.
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Affiliation(s)
- Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Huilin Zhao
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongjian Jiang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Hiroko Watase
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Xihai Zhao
- Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Jianrong Xu
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Dongxiang Xu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
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23
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Gould A, Chen Z, Geleri DB, Balu N, Zhou Z, Chen L, Chu B, Pimentel K, Canton G, Hatsukami T, Yuan C. Vessel length on SNAP MRA and TOF MRA is a potential imaging biomarker for brain blood flow. Magn Reson Imaging 2021; 79:20-27. [PMID: 33689778 DOI: 10.1016/j.mri.2021.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 10/27/2020] [Revised: 02/27/2021] [Accepted: 02/28/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE To explore feasibility of using the vessel length on time-of-flight (TOF) or simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) MRA as an imaging biomarker for brain blood flow, by using arterial spin labeling (ASL) perfusion imaging and 3D phase contrast (PC) quantitative flow imaging as references. METHODS In a population of thirty subjects with carotid atherosclerotic disease, the visible intracranial arteries on TOF and SNAP were semi-automatically traced and the total length of the distal segments was calculated with a dedicated software named iCafe. ASL blood flow was calculated automatically using the recommended hemodynamic model. PC blood flow was obtained by generating cross-sectional arterial images and semi-automatically drawing the lumen contours. Pearson correlation coefficients were used to assess the associations between the different whole-brain or hemispheric blood flow measurements. RESULTS Under the imaging protocol used in this study, TOF vessel length was larger than SNAP vessel length (P < 0.001). Both whole-brain TOF and SNAP vessel length showed a correlation with whole brain ASL and 3D PC blood flow measurements, and the correlation coefficients were higher for SNAP vessel length (TOF vs ASL: R = 0.554, P = 0.002; SNAP vs ASL: R = 0.711, P < 0.001; TOF vs 3D PC: R = 0.358, P = 0.052; SNAP vs 3D PC: R = 0.425, P = 0.019). Similar correlation results were observed for the hemispheric measurements. Hemispheric asymmetry index of SNAP vessel length also showed a significant correlation with hemispheric asymmetry index of ASL cerebral blood flow (R = 0.770, P < 0.001). CONCLUSION The results suggest that length of the visible intracranial arteries on TOF or SNAP MRA can serve as a potential imaging marker for brain blood flow.
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Affiliation(s)
- Anders Gould
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Zhensen Chen
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States.
| | - Duygu Baylam Geleri
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Niranjan Balu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Zechen Zhou
- Philips Research North America, Cambridge, MA, United States
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Baocheng Chu
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Kristi Pimentel
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Gador Canton
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States
| | - Thomas Hatsukami
- Department of Surgery, University of Washington, Seattle, WA, United States
| | - Chun Yuan
- Vascular Imaging Lab, Department of Radiology, University of Washington, Seattle, WA, United States; BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, WA, United States
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24
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Beddhu S, Boucher RE, Sun J, Balu N, Chonchol M, Navaneethan S, Chertow GM, Townsend R, Haley W, Cheung AK, Conroy MB, Raj DS, Xu D, George T, Yunis R, Wei G, Canton G, Bates J, Chen J, Papademetriou V, Punzi H, Wiggers A, Wright JT, Greene T, Yuan C. Chronic kidney disease, atherosclerotic plaque characteristics on carotid magnetic resonance imaging, and cardiovascular outcomes. BMC Nephrol 2021; 22:69. [PMID: 33627066 PMCID: PMC7905597 DOI: 10.1186/s12882-021-02260-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background It is unclear whether faster progression of atherosclerosis explains the higher risk of cardiovascular events in CKD. The objectives of this study were to 1. Characterize the associations of CKD with presence and morphology of atherosclerotic plaques on carotid magnetic resonance imaging (MRI) and 2. Examine the associations of baseline CKD and carotid atherosclerotic plaques with subsequent cardiovascular events. Methods In a subgroup (N = 465) of Systolic Blood Pressure Intervention Trial. (SPRINT) participants, we measured carotid plaque presence and morphology at baseline and after 30-months with MRI. We examined the associations of CKD (baseline eGFR < 60 ml/min/1.73m2) with progression of carotid plaques and the SPRINT cardiovascular endpoint. Results One hundred and ninety six (42%) participants had CKD. Baseline eGFR in the non-CKD and CKD subgroups were 77 ± 14 and 49 ± 8 ml/min/1.73 m2, respectively. Lipid rich necrotic-core plaque was present in 137 (29.5%) participants. In 323 participants with both baseline and follow-up MRI measurements of maximum wall thickness, CKD was not associated with progression of maximum wall thickness (OR 0.62, 95% CI 0.36 to 1.07, p = 0.082). In 96 participants with necrotic core plaque at baseline and with a valid follow-up MRI, CKD was associated with lower odds of progression of necrotic core plaque (OR 0.41, 95% CI 0.17 to 0.95, p = 0.039). There were 28 cardiovascular events over 1764 person-years of follow-up. In separate Cox models, necrotic core plaque (HR 2.59, 95% CI 1.15 to 5.85) but not plaque defined by maximum wall thickness or presence of a plaque component (HR 1.79, 95% CI 0.73 to 4.43) was associated with cardiovascular events. Independent of necrotic core plaque, CKD (HR 3.35, 95% CI 1.40 to 7.99) was associated with cardiovascular events. Conclusions Presence of necrotic core in carotid plaque rather than the presence of plaque per se was associated with increased risk of cardiovascular events. We did not find CKD to be associated with faster progression of necrotic core plaques, although both were independently associated with cardiovascular events. Thus, CKD may contribute to cardiovascular disease principally via mechanisms other than atherosclerosis such as arterial media calcification or stiffening. Trial Registration NCT01475747, registered on November 21, 2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02260-x.
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Affiliation(s)
- Srinivasan Beddhu
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, USA. .,Division of Nephrology & Hypertension, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, Salt Lake City, UT, 84112, USA.
| | - Robert E Boucher
- Division of Nephrology & Hypertension, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, Salt Lake City, UT, 84112, USA
| | - Jie Sun
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
| | - Niranjan Balu
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sankar Navaneethan
- Section of Nephrology, Baylor College of Medicine, Houston, TX, USA.,Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Raymond Townsend
- Division of Nephrology, University of Pennsylvania, Philadelphia, PA, USA
| | - William Haley
- Division of Nephrology, Mayo Clinic, Jacksonville, FL, USA
| | - Alfred K Cheung
- Medical Service, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, USA.,Division of Nephrology & Hypertension, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, Salt Lake City, UT, 84112, USA
| | - Molly B Conroy
- Division of General Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dominic S Raj
- Division of Nephrology, George Washington University, Washington, DC, USA
| | - Dongxiang Xu
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
| | - Thomas George
- Division of Nephrology, Cleveland Clinic, Cleveland, OH, USA
| | - Reem Yunis
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Guo Wei
- Division of Nephrology & Hypertension, University of Utah School of Medicine, 85 North Medical Drive East, Room 201, Salt Lake City, UT, 84112, USA
| | - Gador Canton
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
| | - Jeffrey Bates
- Medical Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jing Chen
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Henry Punzi
- Department of Medicine & Clinical Research, Punzi Medical Center, Carrollton, TX, USA
| | - Alan Wiggers
- Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH, USA
| | - Jackson T Wright
- Division of Nephrology and Hypertension, Case Western Reserve University, Cleveland, OH, USA
| | - Tom Greene
- Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chun Yuan
- Department of Radiology, Vascular Imaging Lab, University of Washington, Seattle, WA, USA
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25
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Zhou Z, Chen S, Balu N, Chu B, Zhao X, Sun J, Mossa-Basha M, Hatsukami T, Börnert P, Yuan C. Neural network enhanced 3D turbo spin echo for MR intracranial vessel wall imaging. Magn Reson Imaging 2021; 78:7-17. [PMID: 33548457 DOI: 10.1016/j.mri.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/28/2020] [Accepted: 01/31/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To improve the signal-to-noise ratio (SNR) and image sharpness for whole brain isotropic 0.5 mm three-dimensional (3D) T1 weighted (T1w) turbo spin echo (TSE) intracranial vessel wall imaging (IVWI) at 3 T. METHODS The variable flip angle (VFA) method enables useful optimization across scan efficiency, SNR and relaxation induced point spread function (PSF) for TSE imaging. A convolutional neural network (CNN) was developed to retrospectively enhance the acquired TSE image with PSF blurring. The previously developed VFA method to increase SNR at the expense of blur can be combined with the presented PSF correction to yield long echo train length (ETL) scan while the acquired image remains high SNR and sharp. The overall approach can enable an optimized solution for accelerated whole brain high-resolution 3D T1w TSE IVWI. Its performance was evaluated on healthy volunteers and patients. RESULTS The PSF blurred image acquired by a long ETL scan can be enhanced by CNN to restore similar sharpness as a short ETL scan, which outperforms the traditional linear PSF enhancement approach. For accelerated whole brain IVWI on volunteers, the optimized isotropic 0.5 mm 3D T1w TSE sequence with CNN based PSF enhancement provides sufficient flow suppression and improved image quality. Preliminary results on patients further demonstrated its improved delineation for intracranial vessel wall and plaque morphology. CONCLUSION The CNN enhanced VFA TSE imaging enables an overall image quality improvement for high-resolution 3D T1w IVWI, and may provide a better tradeoff across scan efficiency, SNR and PSF for 3D TSE acquisitions.
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Affiliation(s)
- Zechen Zhou
- Philips Research North America, Cambridge, MA 02141, United States.
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA 98195, United States
| | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA 98195, United States
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA 98195, United States
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA 98195, United States
| | - Thomas Hatsukami
- Department of Surgery, Division of Vascular Surgery, University of Washington, Seattle, WA 98104, United States
| | | | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA 98195, United States
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Sun J, Lepor NE, Cantón G, Contreras L, Hippe DS, Isquith DA, Balu N, Kedan I, Simonini AA, Yuan C, Zhao XQ, Hatsukami TS. Serial magnetic resonance imaging detects a rapid reduction in plaque lipid content under PCSK9 inhibition with alirocumab. Int J Cardiovasc Imaging 2021; 37:1415-1422. [DOI: 10.1007/s10554-020-02115-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/21/2020] [Indexed: 12/29/2022]
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Burhans MS, Balu N, Schmidt KA, Cromer G, Utzschneider KM, Schur EA, Holte SE, Randolph TW, Kratz M. Impact of the Analytical Approach on the Reliability of MRI-Based Assessment of Hepatic Fat Content. Curr Dev Nutr 2020; 4:nzaa171. [PMID: 33381677 PMCID: PMC7751946 DOI: 10.1093/cdn/nzaa171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/15/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022] Open
Abstract
MRI is a popular noninvasive method for the assessment of liver fat content. After MRI scan acquisition, there is currently no standardized image analysis procedure for the most accurate estimate of liver fat content. We determined intraindividual reliability of MRI-based liver fat measurement using 10 different MRI slice analysis methods in normal-weight, overweight, and obese individuals who underwent 2 same-day abdominal MRI scans. We also compared the agreement in liver fat content between analytical methods and assessed the variability in fat content across the entire liver. Our results indicate that liver fat content varies across the liver, with some slices averaging 54% lower and others 75% higher fat content than the mean of all slices (gold standard). Our data suggest that the entire liver should be contoured on at least every 10th slice to achieve close agreement with the gold standard.
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Affiliation(s)
- Maggie S Burhans
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Kelsey A Schmidt
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Gail Cromer
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kristina M Utzschneider
- VA Puget Sound Health Care System, Seattle, Washington, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ellen A Schur
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sarah E Holte
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Timothy W Randolph
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mario Kratz
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Chen L, Sun J, Canton G, Balu N, Hippe DS, Zhao X, Li R, Hatsukami TS, Hwang JN, Yuan C. Automated Artery Localization and Vessel Wall Segmentation using Tracklet Refinement and Polar Conversion. IEEE Access 2020; 8:217603-217614. [PMID: 33777593 PMCID: PMC7996631 DOI: 10.1109/access.2020.3040616] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Quantitative analysis of blood vessel wall structures is important to study atherosclerotic diseases and assess cardiovascular event risks. To achieve this, accurate identification of vessel luminal and outer wall contours is needed. Computer-assisted tools exist, but manual preprocessing steps, such as region of interest identification and/or boundary initialization, are still needed. In addition, prior knowledge of the ring shape of vessel walls has not been fully explored in designing segmentation methods. In this work, a fully automated artery localization and vessel wall segmentation system is proposed. A tracklet refinement algorithm was adapted to robustly identify the artery of interest from a neural network-based artery centerline identification architecture. Image patches were extracted from the centerlines and converted in a polar coordinate system for vessel wall segmentation. The segmentation method used 3D polar information and overcame problems such as contour discontinuity, complex vessel geometry, and interference from neighboring vessels. Verified by a large (>32000 images) carotid artery dataset collected from multiple sites, the proposed system was shown to better automatically segment the vessel wall than traditional vessel wall segmentation methods or standard convolutional neural network approaches. In addition, a segmentation uncertainty score was estimated to effectively identify slices likely to have errors and prompt manual confirmation of the segmentation. This robust vessel wall segmentation system has applications in different vascular beds and will facilitate vessel wall feature extraction and cardiovascular risk assessment.
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Affiliation(s)
- Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Daniel S. Hippe
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
| | - Xihai Zhao
- Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Rui Li
- Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | | | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, 98195, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
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Sarikaya B, Colip C, Hwang WD, Hippe DS, Zhu C, Sun J, Balu N, Yuan C, Mossa-Basha M. Comparison of time-of-flight MR angiography and intracranial vessel wall MRI for luminal measurements relative to CT angiography. Br J Radiol 2020; 94:20200743. [PMID: 33180559 DOI: 10.1259/bjr.20200743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess whether intracranial vessel wall (IVW) MRI luminal measurements are more accurate than non-contrast 3D-TOF-MRA measurements for intracranial atherosclerotic stenosis, relative to CTA. METHODS Consecutive patients with non-calcified intracranial atherosclerotic stenosis seen on CTA, who had non-contrast 3D-TOF-MRA and IVW performed between 1 January 2013 and 20 April 2014 were selected, and images with stenosis were pre-selected by a single independent rater. The pre-selected CTA, MRA, and IVW (T1-weighted) images were then reviewed by two independent raters blinded to the other measurements in random order. Measurements were made in a plane perpendicular to the lumen on each modality. MRA and IVW measurements were compared to CTA, to determine which more accurately matched the degree of stenosis. RESULTS 18 patients with 33 intracranial atherosclerotic stenoses were included. Relative to CTA, IVW had 40% less variance than MRA (p = .004). IVW had a significantly higher concordance correlation coefficient (CCC) relative to CTA than MRA (.87 vs .68, p = .002). IVW and MRA did not have significant bias relative to CTA, however, 8/33 lesions showed >20% overestimation of the degree of stenosis on MRA, compared to 1/33 for IVW. CCC between raters were 0.84 (95% CI 0.67-0.93) for CTA, 0.83 (0.67-0.93) for TOF-MRA, and 0.85 (0.71-0.94) for IVW. For stenosis >50% sensitivity was 82% for IVW and 64% for MRA, while specificity was 73% for both. CONCLUSION IVW provides more accurate stenosis measurements than MRA when compared to CTA. ADVANCES IN KNOWLEDGE Considering higher stenosis measurement accuracy of IVW, it can be more reliably used for quantitative evaluation relative to MRA.
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Affiliation(s)
- Basar Sarikaya
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Charles Colip
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - William D Hwang
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Chengcheng Zhu
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Jie Sun
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Washington, SA, USA
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Sun J, Lepor N, Canton G, Contreras L, Hippe D, Isquith D, Balu N, Kedan I, Simonini A, Yuan C, Hatsukami T, Zhao X. Effects of alirocumab on carotid plaque lipid content and inflammation: a time course study using serial vessel wall imaging. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0204] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
PCSK9 inhibition has emerged as a potent pharmaceutical approach to lowering LDL cholesterol (LDL-C). Monoclonal anti-PCSK9 antibodies have been shown in recent clinical trials to reduce cardiovascular events in patients with atherosclerotic cardiovascular disease, but the underlying mechanisms are not fully understood. Meanwhile, circulatory inflammation markers were not reduced with PCSK9 inhibitors, thus their effects on plaque inflammation remain elusive. Vessel wall imaging with magnetic resonance (VW-MRI) has enabled serial monitoring of changes in carotid plaque lipid content and inflammation noninvasively that correlates with coronary and carotid vascular events.
Purpose
Using serial VW-MRI, we studied the effects and time course of PCSK9 inhibition with alirocumab on carotid plaque lipid content and inflammation.
Methods
Patients with LDL-C ≥70 mg/dl on ≤70 mg per week atorvastatin or an equivalent (due to statin intolerance or treating-physician discretion) and soft carotid plaque(s) identified on ultrasound underwent carotid VW-MRI. Those with confirmed lipid-rich plaque(s) on VW-MRI received alirocumab (150 mg subcutaneously every other week) and were re-scanned at 3, 6, and 12 months after treatment. Carotid VW-MRI included pre- and post-contrast images for measuring percent lipid-rich necrotic core volume (%LRNC) and dynamic contrast-enhanced images for measuring the extravasation rate of gadolinium contrast (Ktrans, reflecting tissue blood flow, endothelial surface area, and microvessel permeability), a marker of plaque inflammation. The co-primary endpoints were changes in %LRNC and Ktrans at 12 months from baseline.
Results
Of 31 patients enrolled, 27 completed the study (mean age: 69±9; male: 67%; on statins and/or ezetimibe: 41%; median LDL-C: 120 mg/dl [interquartile range: 99, 158]). Alirocumab induced a 59% reduction in LDL-C (p<0.001) on average at 3 months to a median of 54 mg/dl (interquartile range: 29, 69), which was maintained at later time points. From 9.8% at baseline, %LRNC was progressively reduced to 8.4% at 3 months, 7.5% at 6 months, and 7.2% at 12 months, representing a rapid 14% reduction (p=0.032) at 3 months and a total reduction of 20% (p=0.019) at 12 months. From 0.07±0.02 min-1 at baseline, Ktrans was not reduced at 3 or 6 months but was significantly reduced by 17% (p=0.029) at 12 months to 0.06±0.02 min-1. No significant changes in lumen or wall area were observed during the study period.
Conclusions
Serial VW-MRI documented plaque-stabilizing effects of PCSK9 inhibition with alirocumab, including plaque delipidation and attenuation of plaque inflammation. The reduction in plaque lipid content was apparent as early as 3 months. The reduction in Ktrans was not seen until 12 months of treatment and may indicate a later effect on microvascular structure and/or function. This observation represents the earliest time course of plaque morphology modification by non-statin therapy reported to date.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The study was funded by an investigator-initiated grant from Regeneron and Sanofi.
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Affiliation(s)
- J Sun
- University of Washington, Seattle, United States of America
| | - N.E Lepor
- Westside Medical Associates of Los Angeles, Beverly Hills, United States of America
| | - G Canton
- University of Washington, Seattle, United States of America
| | - L Contreras
- Westside Medical Associates of Los Angeles, Beverly Hills, United States of America
| | - D.S Hippe
- University of Washington, Seattle, United States of America
| | - D.A Isquith
- University of Washington, Seattle, United States of America
| | - N Balu
- University of Washington, Seattle, United States of America
| | - I Kedan
- Cedars-Sinai Smidt Heart Institute, Los Angeles, United States of America
| | - A.A Simonini
- Cedars-Sinai Smidt Heart Institute, Los Angeles, United States of America
| | - C Yuan
- University of Washington, Seattle, United States of America
| | - T.S Hatsukami
- University of Washington, Seattle, United States of America
| | - X.Q Zhao
- University of Washington, Seattle, United States of America
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Chen Z, Chen L, Shirakawa M, Liu W, Ortega D, Chen J, Balu N, Trouard T, Hatsukami TS, Zhou W, Yuan C. Intracranial vascular feature changes in time of flight MR angiography in patients undergoing carotid revascularization surgery. Magn Reson Imaging 2020; 75:45-50. [PMID: 33068670 DOI: 10.1016/j.mri.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/05/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To characterize the intracranial vascular features extracted from time of flight (TOF) images and their changes from baseline to follow-up in patients undergoing carotid revascularization, using arterial spin labeling (ASL) cerebral blood flow (CBF) measurement as a reference. METHODS In this retrospective study, brain TOF and ASL images of 99 subjects, acquired before, within 48 h, and/or 6 months after, carotid revascularization surgery were analyzed. TOF images were analyzed using a custom software (iCafe) to quantify intracranial vascular features, including total vessel length, total vessel volume, and number of branches. Mean whole-brain CBF was calculated from ASL images. ASL scans showing low ASL signal in the entire flow territory of an internal carotid artery (ICA), which may be caused by labeling failure, were excluded. Changes and correlations between time points were analyzed separately for TOF intracranial vascular features and ASL CBF. RESULTS Similar to ASL CBF, TOF vascular features (i.e. total vessel length, total vessel volume and number of branches) increased dramatically from baseline to post-surgery, then returned to a level slightly higher than the baseline in long-term follow-up (All P < 0.05). Correlation between time points was observed for all three TOF vascular features but not for ASL CBF. CONCLUSION Intracranial vascular features, including total vessel length, total vessel volume and number of branches, extracted from TOF images are useful in detecting brain blood flow changes induced by carotid revascularization surgery.
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Affiliation(s)
- Zhensen Chen
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, USA
| | - Manabu Shirakawa
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Wenjin Liu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Dakota Ortega
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jinmei Chen
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Theodore Trouard
- Department of Biomedical Engineering, The University of Arizona, Tuscon, AZ, USA
| | | | - Wei Zhou
- Department of Surgery, The University of Arizona, Tuscon, AZ, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA
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Chen L, Canton G, Liu W, Hippe DS, Balu N, Watase H, Hatsukami TS, Waterton JC, Hwang JN, Yuan C. Fully automated and robust analysis technique for popliteal artery vessel wall evaluation (FRAPPE) using neural network models from standardized knee MRI. Magn Reson Med 2020; 84:2147-2160. [PMID: 32162395 PMCID: PMC8320767 DOI: 10.1002/mrm.28237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/27/2020] [Accepted: 02/07/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop a fully automated vessel wall (VW) analysis workflow (fully automated and robust analysis technique for popliteal artery evaluation, FRAPPE) on the popliteal artery in standardized knee MR images. METHODS Popliteal artery locations were detected from each MR slice by a deep neural network model and connected into a 3D artery centerline. Vessel wall regions around the centerline were then segmented using another neural network model for segmentation in polar coordinate system. Contours from vessel wall segmentations were used for vascular feature calculation, such as mean wall thickness and wall area. A transfer learning and active learning framework was applied in training the localization and segmentation neural network models to maintain accuracy while reducing manual annotations. This new popliteal artery analysis technique (FRAPPE) was validated against manual segmentation qualitatively and quantitatively in a series of 225 cases from the Osteoarthritis Initiative (OAI) dataset. RESULTS FRAPPE demonstrated high accuracy and robustness in locating popliteal arteries, segmenting artery walls, and quantifying arterial features. Qualitative evaluations showed 1.2% of slices had noticeable major errors, including segmenting the wrong target and irregular vessel wall contours. The mean Dice similarity coefficient with manual segmentation was 0.79, which is comparable to inter-rater variations. Repeatability evaluations show most of the vascular features have good to excellent repeatability from repeated scans of same subjects, with intra-class coefficient ranging from 0.80 to 0.98. CONCLUSION This technique can be used in large population-based studies, such as OAI, to efficiently assess the burden of atherosclerosis from routine MR knee scans.
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Affiliation(s)
- Li Chen
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Gador Canton
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Wenjin Liu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S. Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Hiroko Watase
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | - John C. Waterton
- Centre for Imaging Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
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33
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Watase H, Shen M, Sui B, Gao P, Zhang D, Sun J, Balu N, Hippe DS, Jarvik GP, Zhao X, Li R, Chen S, Yuan C, Hatsukami TS. Differences in atheroma between Caucasian and Asian subjects with anterior stroke: A vessel wall MRI study. Stroke Vasc Neurol 2020; 6:25-32. [PMID: 32792458 PMCID: PMC8005910 DOI: 10.1136/svn-2020-000370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/20/2020] [Accepted: 06/17/2020] [Indexed: 01/25/2023] Open
Abstract
Background and purpose While extracranial carotid artery stenosis is more common among Caucasians and intracranial artery stenosis is more common among Asians, the differences in atherosclerotic plaque characteristics have not yet been extensively examined. We sought to investigate plaque location and characteristics within extracranial carotid and intracranial arteries in symptomatic Caucasians and Chinese using vessel wall MRI. Methods Subjects with recent anterior circulation ischaemic stroke were recruited and imaged at two sites in the USA and China using similar protocols. Both extracranial carotid and intracranial arteries were reviewed to determine plaque location and characteristics. Results The prevalence of extracranial carotid plaque in Caucasians and Chinese was 73.1% and 49.1%, respectively (p=0.055). Prevalence of intracranial plaque was 38.5% and 69.1% in Caucasians and Chinese, respectively (p=0.02). Furthermore, 42% of Caucasians and 16% of Chinese had high-risk plaque (HRP) features (intraplaque haemorrhage, luminal surface disruption) in the extracranial carotid artery (p=0.03). The prevalence of HRP features in intracranial arteries was not significantly different between the two cohorts (4% vs 11%; p=0.42). Conclusions Differences in the location and characteristics of cerebrovascular atherosclerosis were identified by vessel wall MRI in US Caucasian and Chinese subjects with recent anterior circulation ischaemic stroke. Extracranial carotid plaques with HRP features were more common in Caucasians. Intracranial plaques were more common in Chinese subjects, but no significant difference between the two cohorts in intracranial HRP prevalence was found. Larger studies using vessel wall imaging to investigate racial differences in cerebrovascular disease may inform underlying mechanisms of HRP development and may ultimately help guide appropriate therapy.
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Affiliation(s)
- Hiroko Watase
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Mi Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Binbin Sui
- Tiantan Neuroimaging Center for Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Gail P Jarvik
- Department Medicine (Medical Genetics) and Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
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Brunnquell CL, Hoff MN, Balu N, Nguyen XV, Oztek MA, Haynor DR. Making Magnets More Attractive: Physics and Engineering Contributions to Patient Comfort in MRI. Top Magn Reson Imaging 2020; 29:167-174. [PMID: 32541257 DOI: 10.1097/rmr.0000000000000246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patient comfort is an important factor of a successful magnetic resonance (MR) examination, and improvements in the patient's MR scanning experience can contribute to improved image quality, diagnostic accuracy, and efficiency in the radiology department, and therefore reduced cost. Magnet designs that are more open and accessible, reduced auditory noise of MR examinations, light and flexible radiofrequency (RF) coils, and faster motion-insensitive imaging techniques can all significantly improve the patient experience in MR imaging. In this work, we review the design, development, and implementation of these physics and engineering approaches to improve patient comfort.
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Affiliation(s)
- Christina L Brunnquell
- Department of Radiology, University of Washington, Seattle, WA Department of Radiology, The Ohio State University Wexler Medical Center, Columbus, OH
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Chen Z, Zhou Z, Qi H, Chen H, Chu B, Hatsukami TS, Yuan C, Balu N. A novel sequence for simultaneous measurement of whole-brain static and dynamic MRA, intracranial vessel wall image, and T 1 -weighted structural brain MRI. Magn Reson Med 2020; 85:316-325. [PMID: 32738091 DOI: 10.1002/mrm.28431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/18/2020] [Revised: 06/08/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE To propose a highly time-efficient imaging technique named improved simultaneous noncontrast angiography and intraplaque hemorrhage (iSNAP) for simultaneous assessment of lumen, vessel wall, and blood flow in intracranial arteries. METHODS iSNAP consists of pulsed arterial spin labeling preparations and 3D golden angle radial acquisition. Images were reconstructed by k-space weighted image contrast (KWIC) method with optimized data-sharing strategies. Dynamic MRA for blood flow assessment was obtained from iSNAP by reconstruction at multiple inversion times and image subtraction, static MRA by both image subtraction approach and phase-sensitive inversion recovery technique, and vessel wall images by both reconstruction at zero-crossing time-point of blood and phase-sensitive inversion recovery. A T1 -weighted brain MRI was also reconstructed from iSNAP. Preliminary comparison of iSNAP against the dedicated dynamic MRA sequence 4D-TRANCE, MRA/vessel wall imaging sequence SNAP, and vessel wall imaging sequence T1 -weighted VISTA was performed in healthy volunteers and patients. RESULTS iSNAP has whole-brain coverage and takes ~6.5 min. The dedicated reconstruction strategies are feasible for each iSNAP image contrast and beneficial for image SNR. iSNAP-dynamic MRA yields similar dynamic flow information as 4D-TRANCE and allows more flexible temporal resolution. The 2 types of iSNAP static MRA images complement each other in characterizing both proximal large arteries and distal small arteries. Depiction of vessel wall lesions in iSNAP vessel wall images is better than SNAP and may be similar to T1 -weighted VISTA, although the images are slightly blurred. CONCLUSION iSNAP provides a time-efficient evaluation of intracranial arteries and may have great potential for comprehensive assessment of intracranial vascular conditions using a single sequence.
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Affiliation(s)
- Zhensen Chen
- Vascular Imaging Lab and BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Zechen Zhou
- Philips Research North America, Cambridge, Massachusetts, USA
| | - Haikun Qi
- School of Biomedical Engineering & Imaging Science, King's College London, London, United Kingdom
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, People's Republic of China
| | - Baocheng Chu
- Vascular Imaging Lab and BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Vascular Imaging Lab and BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Vascular Imaging Lab and BioMolecular Imaging Center, Department of Radiology, University of Washington, Seattle, Washington, USA
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Liu W, Balu N, Canton G, Hippe DS, Watase H, Waterton JC, Hatsukami T, Yuan C. Understanding Atherosclerosis Through an Osteoarthritis Data Set. Arterioscler Thromb Vasc Biol 2020; 39:1018-1025. [PMID: 31070477 DOI: 10.1161/atvbaha.119.312513] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Atherosclerotic cardiovascular disease remains a worldwide epidemic and one of the leading causes of death nowadays. Vessel wall imaging can be used to understand the development and progression of atherosclerosis, but it is rarely done because of the high cost. We recently identified the Osteoarthritis Initiative, a large prospective cohort study of knee osteoarthritis, which might serve as a valuable source for atherosclerosis research with its serial knee magnetic resonance imaging data. We have found that these images are suitable for vessel wall image analysis of the lower extremity arteries. Here, we will introduce the Osteoarthritis Initiative data set and explain why it could be used for cardiovascular research purposes. Also, we will briefly comment on peripheral artery atherosclerosis as it is covered in the Osteoarthritis Initiative image data set and review the use of vessel wall imaging for studying atherosclerosis. We think data mining of imaging studies, not originally designed on cardiovascular research, can not only maximize the value of the imaging data set but also boost our understanding of atherosclerosis.
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Affiliation(s)
- Wenjin Liu
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Niranjan Balu
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Gador Canton
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Daniel S Hippe
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Division of Vascular Surgery, Department of Surgery (H.W., T.H.), University of Washington, Seattle
| | - John C Waterton
- Centre for Imaging Sciences, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom (J.C.W.)
| | - Thomas Hatsukami
- Division of Vascular Surgery, Department of Surgery (H.W., T.H.), University of Washington, Seattle
| | - Chun Yuan
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
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Hippe DS, Balu N, Chen L, Canton G, Liu W, Watase H, Waterton JC, Hatsukami TS, Hwang JN, Yuan C. Confidence Weighting for Robust Automated Measurements of Popliteal Vessel Wall Magnetic Resonance Imaging. Circ Genom Precis Med 2020; 13:e002870. [PMID: 31928231 DOI: 10.1161/circgen.119.002870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel S Hippe
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
| | - Niranjan Balu
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
| | - Li Chen
- Department of Electrical and Computer Engineering (L.C., J.-N.H.), University of Washington, Seattle
| | - Gador Canton
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
| | - Wenjin Liu
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Division of Vascular Surgery, Department of Surgery (H.W., T.S.H.), University of Washington, Seattle
| | - John C Waterton
- Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, United Kingdom. (J.C.W.)
| | - Thomas S Hatsukami
- Division of Vascular Surgery, Department of Surgery (H.W., T.S.H.), University of Washington, Seattle
| | - Jenq-Neng Hwang
- Department of Electrical and Computer Engineering (L.C., J.-N.H.), University of Washington, Seattle
| | - Chun Yuan
- Department of Radiology (D.S.H., N.B., G.C., W.L., C.Y.), University of Washington, Seattle
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Murata K, Murata N, Chu B, Watase H, Hippe DS, Balu N, Sun J, Zhao X, Hatsukami TS, Yuan C. Characterization of Carotid Atherosclerotic Plaques Using 3-Dimensional MERGE Magnetic Resonance Imaging and Correlation With Stroke Risk Factors. Stroke 2020; 51:475-480. [PMID: 31902332 DOI: 10.1161/strokeaha.119.027779] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- High-resolution magnetic resonance imaging is capable of characterizing carotid atherosclerotic plaque morphology and composition. Most reported carotid plaque imaging techniques are 2-dimensional (2D) based with limited longitudinal coverage of ≈30 mm, which may be insufficient for complete visualization of extracranial carotid atheroma. A 3D black-blood imaging technique, motion-sensitized driven equilibrium prepared rapid gradient echo technique (3D-MERGE) can provide larger coverage. We sought to use 3D-MERGE to investigate carotid atherosclerosis plaque distribution and to analyze their correlation with clinical information and stroke risk factors. Methods- From 5 hospitals in China, 97 subjects suspected of recent stroke or transient ischemic attack were imaged with 3D-MERGE within 2 weeks of symptoms using 3T magnetic resonance imaging. Images were analyzed by 2 reviewers. Plaque length was calculated and categorized as plaques within, partially outside, or completely outside of typical 2D magnetic resonance imaging coverage. Associations between plaque features and clinical information, stroke risk factors were assessed. Results- Ninety-seven subjects with 194 carotid arteries (70 men and 27 women, mean age 60 years) were analyzed. Of the 136 plaques identified, 68 (50%) were within, 46 (33.8%) were partially outside, and 22 (16.2%) were completely outside of 2D magnetic resonance imaging coverage. Total plaque length was significantly positively associated with male sex (P<0.001), hypertension (P=0.011), and history of smoking (P<0.001). Hypertensive subjects were more likely to have at least one plaque completely outside the 2D magnetic resonance imaging coverage than nonhypertensive subjects (P=0.007). Conclusions- The 3D-MERGE allows for the identification of substantially more carotid plaques than 2D black-blood techniques. The extent and distribution of plaque, identified by the larger coverage afforded by 3D-MERGE, were found to correlate significantly with male sex and risk factors that are common among patients with stroke, including hypertension and history of cigarette smoking.
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Affiliation(s)
- Kiyoko Murata
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle.,Department of Neurology, Toho University Omori Medical center, Tokyo, Japan (K.M.)
| | - Nozomu Murata
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle.,Department of Radiology, Toho University Ohashi Medical Center, Tokyo, Japan (N.M.)
| | - Baocheng Chu
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Department of Surgery (H.W., T.S.H.), University of Washington, Seattle
| | - Daniel S Hippe
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
| | - Niranjan Balu
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
| | - Jie Sun
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China (X.Z.)
| | | | - Chun Yuan
- From the Department of Radiology (K.M., N.M., B.C., D.S.H., N.B., J.S., C.Y.), University of Washington, Seattle
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Cattaneo M, Sun J, Staub D, Xu D, Gallino J, Santini P, Porretta A, Yuan C, Balu N, Arnold M, Froio A, Limoni C, Wyttenbach R, Gallino A. Imaging of Carotid Plaque Neovascularization by Contrast-Enhanced Ultrasound and Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Cerebrovasc Dis 2019; 48:140-148. [DOI: 10.1159/000504042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 10/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background: Carotid plaque neovascularization (vasa vasorum [VV]) may be useful for detecting high-risk atherosclerotic plaques. Contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are 2 commonly used techniques for imaging VV of the carotid plaque, yet the relationship between their measurements remains unknown. Objectives: We aimed to blindly evaluate the correlation between CEUS and DCE-MRI in measuring carotid plaque VV. Methods: We recruited subjects with asymptomatic carotid stenosis (≥50%). VV was graded by CEUS, based on richness of contrast signal, according to 3 different methods named CEUS_A, CEUS_B and CEUS_C on different point scales (the higher the values, the higher the estimated VV). A 3.0 T MRI scanner was used for VV quantification by DCE-MRI using gadolinium contrast kinetic modelling for computing the fractional plasma volume (vp) and transfer constant (Ktrans). Results: The analysis included 30 patients. A significant correlation between CEUS and DCE-MRI findings was observed when CEUS_C was used for neovessel grading and DCE-MRI was used to determine adventitial (r = 0.460, p = 0.010) and plaque (r = 0.374, p = 0.042) Ktrans values. CEUS_B (r = 0.416, p = 0.022) and CEUS_C (r = 0.443, p = 0.014) grading showed a significant correlation with regard to the maximal Ktrans. Conclusions: We found a positive but weak correlation and a moderate diagnostic agreement between neovessels as visually graded by CEUS and adventitial neovessels assessed by DCE-MRI Ktrans in carotid atherosclerosis. These findings may help in understanding how VV density, flow, and permeability influence in vivo measurements by CEUS and DCE-MRI as well as in selecting the most appropriate variables and imaging method in future research and potentially in clinical settings. Further confirmative studies are necessary to confirm our results.
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Liu H, Sun J, Hippe DS, Wu W, Chu B, Balu N, Hatsukami T, Yuan C. Improved carotid lumen delineation on non-contrast MR angiography using SNAP (Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage) imaging. Magn Reson Imaging 2019; 62:87-93. [PMID: 31247251 DOI: 10.1016/j.mri.2019.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/19/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE Simultaneous Non-Contrast Angiography and Intraplaque Hemorrhage (SNAP) was developed for improved imaging of intraplaque hemorrhage (IPH). Its signal polarity also allows for non-contrast time-of-flight MR angiography (TOF). This study sought to compare SNAP and TOF in delineating carotid lumen using contrast-enhanced MRA (CE-MRA) as the reference standard. MATERIALS AND METHODS Two hundred and eighty-nine matched slices from 15 arteries among 11 subjects (9 males and 2 females, mean age of 72.1 ± 8.6 years) with luminal stenosis on CE-MRA were studied. Cross-sectional slices centered around the carotid bifurcation were matched between the three MRA techniques (SNAP, TOF, and CE-MRA) and classified as slices with or without plaque (focal wall thickness ≥ 1.5 mm) by additional black-blood vessel wall MRI. Lumen area was measured using a Sobel gradient map for TOF and CE-MRA (magnitude images) and a polarity map for SNAP. Agreement between techniques for measuring lumen area and percent stenosis was evaluated using intraclass correlation coefficient (ICC) and paired t-test. RESULTS Among the 289 matched slices, SNAP showed a higher agreement with CE-MRA than TOF for measuring lumen area (ICC: 0.93 vs. 0.83; p = 0.03). Agreement with CE-MRA was high for both SNAP and TOF in slices without plaque (ICC: 0.91 vs. 0.89; p > 0.05) but favored SNAP over TOF in slices with plaque (ICC: 0.93 vs. 0.80; p = 0.02). CONCLUSION SNAP, assisted by signal polarity information, demonstrated a higher agreement with CE-MRA in delineating carotid lumen compared to TOF, particularly in slices with plaque where flow conditions may be more complex.
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Affiliation(s)
- Haining Liu
- Department of Radiology, University of Washington, Seattle, WA 98109, United States.
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA 98109, United States
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA 98109, United States
| | - Wei Wu
- Department of Radiology, University of Washington, Seattle, WA 98109, United States; Tongji Hospital, Tongji Medical College Affiliated to Huazhong University of Science and Technology, Department of Radiology, 1095 Jiefang Avenue, Wuhan 430000, China
| | - Baocheng Chu
- Department of Radiology, University of Washington, Seattle, WA 98109, United States
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA 98109, United States
| | - Thomas Hatsukami
- Department of Surgery, University of Washington, Seattle, WA 98109, United States
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA 98109, United States; Department of Bioengineering, University of Washington, Seattle, WA 98109, United States; Department of Bioengineering, Tsinghua University, Beijing 100084, China
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Chen L, Sun J, Hippe DS, Balu N, Yuan Q, Yuan I, Zhao X, Li R, He L, Hatsukami TS, Hwang JN, Yuan C. Quantitative assessment of the intracranial vasculature in an older adult population using iCafe. Neurobiol Aging 2019; 79:59-65. [PMID: 31026623 DOI: 10.1016/j.neurobiolaging.2019.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/04/2019] [Accepted: 02/28/2019] [Indexed: 01/11/2023]
Abstract
Comprehensive quantification of intracranial artery features may help us assess and understand variations of blood supply during brain development and aging. We analyzed vasculature features of 163 participants (age 56-85 years, mean of 71) from a community study to investigate if any of the features varied with age. Three-dimensional time-of-flight magnetic resonance angiography images of these participants were processed in IntraCranial artery feature extraction technique (a recently developed technique to obtain quantitative features of arteries) to divide intracranial vasculatures into anatomical segments and generate 8 morphometry and intensity features for each segment. Overall, increase in age was found negatively associated with number of branches and average order of intracranial arteries while positively associated with tortuosity, which remained after adjusting for cardiovascular risk factors. The associations with number of branches and average order were consistently found between 3 main intracranial artery regions, whereas the association with tortuosity appeared to be present only in middle cerebral artery/distal arteries. The combination of time-of-flight magnetic resonance angiography and IntraCranial artery feature extraction technique may provide an effective way to study vascular conditions and changes in the aging brain.
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Affiliation(s)
- Li Chen
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Quan Yuan
- Department of Neurology, Xuanwu hospital, Capital Medical University, Beijing, China
| | | | - Xihai Zhao
- Biomedical Engineering, Tsinghua University, Beijing, China
| | - Rui Li
- Biomedical Engineering, Tsinghua University, Beijing, China
| | - Le He
- Biomedical Engineering, Tsinghua University, Beijing, China
| | | | - Jenq-Neng Hwang
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA.
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Liu J, Sun J, Balu N, Ferguson MS, Wang J, Kerwin WS, Hippe DS, Wang A, Hatsukami TS, Yuan C. Semiautomatic carotid intraplaque hemorrhage volume measurement using 3D carotid MRI. J Magn Reson Imaging 2019; 50:1055-1062. [PMID: 30861249 DOI: 10.1002/jmri.26698] [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: 11/21/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Presence of intraplaque hemorrhage (IPH) is a known risk factor for stroke and plaque progression. Accurate and reproducible measurement of IPH volume are required for further risk stratification. PURPOSE To develop a semiautomatic method to measure carotid IPH volume. STUDY TYPE Retrospective. POPULATION Patients scheduled for carotid endarterectomy and patients with 16-79% asymptomatic carotid stenosis by ultrasound. FIELD STRENGTH 3T. SEQUENCE Simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) MRI. ASSESSMENT A semiautomated volumetric measurement of IPH using signal intensity thresholding of 3D SNAP volume was implemented. Fourteen carotid endarterectomy patients were enrolled to determine the signal intensity threshold of IPH using histology. Thirty-three patients with 16-79% asymptomatic stenosis were scanned twice within 1 month to evaluate reproducibility. The normalized SNAP intensity with the highest Youden index for predicting IPH on histology was used for thresholding. Scan-rescan reproducibility of IPH measurement was assessed using the intraclass correlation coefficient (ICC) and coefficient of variation (CV). STATISTICAL TESTS Receiver operating characteristic curve, area under the curve, Cohen's kappa, intraclass correlation coefficient, coefficient of variance (CV), and paired t-test. RESULTS IPH detection by the algorithm had substantial agreement with manual review (kappa: 0.92; 95% confidence interval [CI]: 0.83, 1.00) and moderate agreement with histology (kappa: 0.55; 95% CI: 0.34, 0.68). IPH volume measurements by the algorithm were strongly correlated with histology (Spearman's rho = 0.76, P = 0.002). IPH measurements were also reproducible, with ICCs of 0.86 (95% CI: 0.57, 0.96), 0.77 (95% CI: 0.32, 0.94), and 0.99 (95% CI: 0.93, 1.00) for maximum/mean normalized intensity and IPH volume, respectively. The corresponding CVs were 10.6%, 5.2%, and 11.8%. DATA CONCLUSION IPH volume measurements on SNAP MRI are highly reproducible using semiautomatic measurement. Level of Evidence 2 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2019;50:1055-1062.
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Affiliation(s)
- Jin Liu
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Marina S Ferguson
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Jinnan Wang
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - William S Kerwin
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Amy Wang
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Department of Bioengineering, University of Washington, Seattle, Washington, USA.,Department of Radiology, University of Washington, Seattle, Washington, USA
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Mossa-Basha M, Watase H, Sun J, Shibata DK, Hippe DS, Balu N, Hatsukami T, Yuan C. Inter-rater and scan-rescan reproducibility of the detection of intracranial atherosclerosis on contrast-enhanced 3D vessel wall MRI. Br J Radiol 2019; 92:20180973. [PMID: 30789784 DOI: 10.1259/bjr.20180973] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The objective is to establish interscan, inter- and intra-rater reproducibility of a multicontrast three-dimensional contrast-enhanced intracranial vessel wall (IVW) MRI protocol with 0.6 mm acquired (0.3 mm interpolated) isotropic resolution in the detection of intracranial atherosclerosis. METHODS Subjects with established intracranial atherosclerosis were prospectively recruited and underwent two contrast-enhanced three-dimensional IVW scans within a 2-week period. Four raters with varying degrees of vessel wall imaging interpretation experience, through an iterative training process developed guidelines for plaque identification with no, possible and definite plaque categories. Using these guidelines, the raters reviewed the cases in pairs (consensus rating), while blinded to the interpretations of the other pair, clinical reports and patient history. The rater pairs reviewed 19 segments per patient for the presence and location of atherosclerotic plaques. Inter-scan, inter rater and intra rater reproducibility were assessed. RESULTS 19 subjects were scanned twice, with 361 total segments reviewed and 304-324 evaluable segments analyzed in the different reproducibility assessments. Overall inter-rater agreement for possible and definite plaque was 88.9 % [κ = 0.73; 95% confidence interval (CI) (0.62-0.81)], inter-scan/intra-rater agreement was 82.1 % [κ = 0.58; 95% CI (0.48-0.70)] and inter-scan/inter-rater agreement of 84.5% [κ = 0.64; 95% CI (0.51 - 0.76)]. CONCLUSION Contrast-enhanced IVW imaging, with the utilization of detailed plaque definition guidelines for image review, can be a reproducible technique for the evaluation of intracranial atherosclerosis. ADVANCES IN KNOWLEDGE This work is the first to establish reproducibility of IVW for plaque identification with and without contrast. Reproducibility using contrast is important as most IVW applications rely on lesion enhancement.
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Affiliation(s)
- Mahmud Mossa-Basha
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Hiroko Watase
- 2 Department of Surgery, University of Washington School of Medicine , Seattle , United States
| | - Jie Sun
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Dean K Shibata
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Daniel S Hippe
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Niranjan Balu
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
| | - Thomas Hatsukami
- 2 Department of Surgery, University of Washington School of Medicine , Seattle , United States
| | - Chun Yuan
- 1 Department of Radiology, University of Washington School of Medicine , Seattle , United States
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Hartman JB, Watase H, Sun J, Hippe DS, Kim L, Levitt M, Sekhar L, Balu N, Hatsukami T, Yuan C, Mossa-Basha M. Intracranial aneurysms at higher clinical risk for rupture demonstrate increased wall enhancement and thinning on multicontrast 3D vessel wall MRI. Br J Radiol 2019; 92:20180950. [PMID: 30653339 DOI: 10.1259/bjr.20180950] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Identification of aneurysms at risk for rupture is important and challenging. We sought to evaluate if intracranial vessel wall (IVW) imaging characteristics of unruptured aneurysms correlate with clinical risk factors for rupture. METHODS: Patients with unruptured intracranial aneurysms were prospectively recruited and underwent a multi contrast 3D IVW protocol between April 6, 2016 and August 29, 2017. Two independent raters, blinded to aneurysm vulnerability, evaluated each aneurysm for wall enhancement, extent of enhancement in terms of the numbers of quadrants enhancing circumferentially, intensity of enhancement, and qualitative wall thinning. PHASES score was calculated for each aneurysm. Univariate logistic regression analysis was used to compare IVW characteristics between aneurysms at higher clinical risk for rupture (PHASES score > 3) and lower clinical risk for rupture (PHASES score ≤ 3). RESULTS: 45 patients with 65 unruptured aneurysms were analyzed; 38 aneurysms with PHASES score > 3 (58%) and 27 aneurysms with PHASES score ≤ 3 (42%). Aneurysms with PHASES score > 3 were more likely to demonstrate enhancement (42.1% vs 14.8%, p = 0.022), greater extent of enhancement (mean: 2.9 vs 2.2 quadrants, p = 0.063), and wall thinning (9.2% vs 0%, p = 0.044). Inter-reader agreement was moderate-to-good for the presence (κ = 0.64), extent (κ = 0.64), and intensity of enhancement (κ = 0.60) but relatively low for wall thinning (κ = 0.25). CONCLUSION: Aneurysms at higher risk of rupture by PHASES score are more likely to demonstrate wall enhancement, more diffuse enhancement, and wall thinning on IVW. ADVANCES IN KNOWLEDGE: This study prospectively compares IVW-detected wall enhancement and thinning between unruptured aneurysms stratified into high and low risk groups by clinical scores (PHASES) of vulnerability.
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Affiliation(s)
| | - Hiroko Watase
- 2 Department of Surgery, University of Washington , Seattle, WA , USA
| | - Jie Sun
- 1 Department of Radiology, University of Washington , Seattle, WA , USA
| | - Daniel S Hippe
- 1 Department of Radiology, University of Washington , Seattle, WA , USA
| | - Louis Kim
- 1 Department of Radiology, University of Washington , Seattle, WA , USA.,3 Department of Neurological Surgery, University of Washington , Seattle, WA , USA
| | - Michael Levitt
- 1 Department of Radiology, University of Washington , Seattle, WA , USA.,3 Department of Neurological Surgery, University of Washington , Seattle, WA , USA.,4 Department of Mechanical Engineering, University of Washington , Seattle, WA , USA
| | - Laligam Sekhar
- 3 Department of Neurological Surgery, University of Washington , Seattle, WA , USA
| | - Niranjan Balu
- 1 Department of Radiology, University of Washington , Seattle, WA , USA
| | - Thomas Hatsukami
- 2 Department of Surgery, University of Washington , Seattle, WA , USA
| | - Chun Yuan
- 1 Department of Radiology, University of Washington , Seattle, WA , USA
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Chen L, Mossa-Basha M, Sun J, Hippe DS, Balu N, Yuan Q, Pimentel K, Hatsukami TS, Hwang JN, Yuan C. Quantification of morphometry and intensity features of intracranial arteries from 3D TOF MRA using the intracranial artery feature extraction (iCafe): A reproducibility study. Magn Reson Imaging 2018; 57:293-302. [PMID: 30580079 DOI: 10.1016/j.mri.2018.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/25/2018] [Revised: 11/22/2018] [Accepted: 12/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Accurate and reliable vascular features extracted from 3D time-of-flight (TOF) magnetic resonance angiography (MRA) can help evaluate cerebral vascular diseases and conditions. The goal of this study was to evaluate the reproducibility of an intracranial artery feature extraction (iCafe) algorithm for quantitative analysis of intracranial arteries from TOF MRA. METHODS Twenty-four patients with known intracranial artery stenosis were recruited and underwent two separate MRA scans within 2 weeks of each other. Each dataset was blinded to associated imaging and clinical data and then processed independently using iCafe. Inter-scan reproducibility analysis was performed on the 24 pairs of scans while intra-/inter-operator reproducibility and stenosis detection were assessed on 8 individual MRA scans. After tracing the vessels visualized on TOF MRA, iCafe was used to automatically extract the locations with stenosis and eight other vascular features. The vascular features included the following six morphometry and two signal intensity features: artery length (total, distal, and proximal), volume, number of branches, average radius of the M1 segment of the middle cerebral artery, and average normalized intensity of all arteries and large vertical arteries. A neuroradiologist independently reviewed the images to identify locations of stenosis for the reference standard. Reproducibility of stenosis detection and vascular features was assessed using Cohen's kappa, the intra-class correlation coefficient (ICC), and within-subject coefficient of variation (CV). RESULTS The segment-based sensitivity of iCafe for stenosis detection ranged from 83.3-91.7% while specificity was 97.4%. Kappa values for inter-scan and intra-operator reproducibility were 0.73 and 0.77, respectively. All vascular features demonstrated excellent inter-scan and intra-operator reproducibility (ICC = 0.91-1.00, and CV = 1.21-8.78% for all markers), and good to excellent inter-operator reproducibility (ICC = 0.76-0.99, and CV = 3.27-15.79% for all markers). CONCLUSION Intracranial artery features can be reliably quantified from TOF MRA using iCafe to provide both clinical diagnostic assistance and facilitate future investigative quantitative analyses.
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Affiliation(s)
- Li Chen
- Department of Electrical Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington, Seattle, WA 98195, USA.
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA 98195, USA.
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA 98195, USA.
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA 98195, USA.
| | - Quan Yuan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kristi Pimentel
- Department of Radiology, University of Washington, Seattle, WA 98195, USA.
| | - Thomas S Hatsukami
- Department of Surgery, University of Washington, Seattle, WA 98195, USA.
| | - Jenq-Neng Hwang
- Department of Electrical Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA 98195, USA.
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46
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Qi H, Sun J, Qiao H, Zhao X, Guo R, Balu N, Yuan C, Chen H. Simultaneous T 1 and T 2 mapping of the carotid plaque (SIMPLE) with T 2 and inversion recovery prepared 3D radial imaging. Magn Reson Med 2018; 80:2598-2608. [PMID: 29802629 DOI: 10.1002/mrm.27361] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 12/15/2017] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To propose a technique that can produce different T1 and T2 contrasts in a single scan for simultaneous T1 and T2 mapping of the carotid plaque (SIMPLE). METHODS An interleaved 3D golden angle radial trajectory was used in conjunction with T2 preparation with variable duration (TEprep ) and inversion recovery pulses. Sliding window reconstruction was adopted to reconstruct images at different inversion delay time and TEprep for joint T1 and T2 fitting. In the fitting procedure, a rapid B1 correction method was presented. The accuracy of SIMPLE was investigated in phantom experiments. In vivo scans were performed on 5 healthy volunteers with 2 scans each, and on 5 patients with carotid atherosclerosis. RESULTS The phantom T1 and T2 estimations of SIMPLE agreed well with the standard methods with the percentage difference smaller than 7.1%. In vivo T1 and T2 for normal carotid vessel wall were 1213 ± 48.3 ms and 51.1 ± 1.7 ms, with good interscan repeatability. Alternations of T1 and T2 in plaque regions were in agreement with the conventional multicontrast imaging findings. CONCLUSION The proposed SIMPLE allows simultaneous T1 and T2 mapping of the carotid artery in less than 10 minutes, serving as a quantitative tool with good accuracy and reproducibility for plaque characterization.
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Affiliation(s)
- Haikun Qi
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, Washington
| | - Huiyu Qiao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Rui Guo
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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47
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Chen S, Zhao H, Li J, Zhou Z, Li R, Balu N, Yuan C, Chen H, Zhao X. Evaluation of carotid atherosclerotic plaque surface characteristics utilizing simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) technique. J Magn Reson Imaging 2018; 47:634-639. [PMID: 28766810 PMCID: PMC5796877 DOI: 10.1002/jmri.25815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/27/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the feasibility of the Simultaneous Noncontrast Angiography and intraPlaque hemorrhage (SNAP) technique in identification of carotid plaque surface characteristics compared with the conventional multicontrast vessel wall imaging protocol. MATERIALS AND METHODS Thirty symptomatic patients with carotid plaque were recruited and underwent carotid artery magnetic resonance imaging (MRI) (3.0T) using a conventional multicontrast protocol and SNAP sequence. As an intrinsic multicontrast sequence, SNAP could generate a gray blood reference (Ref) image set, a black blood corrected real (CR) image set, and a bright blood MR angiography (MRA) image set. A bright blood SNAP Ref2 image was implemented by combining Ref and MRA images for facilitating plaque surface characteristics evaluation. The presence/absence of calcification (CA), juxtaluminal calcification (JCA), and ulceration was assessed. The agreement between SNAP and multicontrast vessel wall protocol in identifying CA, JCA, and ulceration was analyzed using Cohen's kappa analysis. The interreader and intrareader reproducibility of SNAP imaging in identifying plaque surface characteristics was also assessed. RESULTS Good to excellent agreement was found between SNAP and conventional multicontrast protocol in identifying CA (κ = 0.74, 95% confidence interval [CI]: 0.54-0.93), JCA (κ = 0.81, 95% CI: 0.66-0.97), and ulceration (κ = 0.82, 95% CI: 0.65-0.99). In addition, excellent intrareader and interreader reproducibility was found for SNAP imaging in identification of CA, JCA, and ulceration. CONCLUSION SNAP imaging showed excellent agreement with multicontrast imaging and high reproducibility in identification of both JCA and ulceration, suggesting that SNAP imaging may be a time-efficient, alternative tool in identification of plaque surface characteristics in carotid arteries. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:634-639.
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Affiliation(s)
- Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Jifan Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Zechen Zhou
- Healthcare Department, Philips Research China, Shanghai, P.R. China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, P.R. China
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Watase H, Sun J, Hippe DS, Balu N, Li F, Zhao X, Mani V, Fayad ZA, Fuster V, Hatsukami TS, Yuan C. Carotid Artery Remodeling Is Segment Specific: An In Vivo Study by Vessel Wall Magnetic Resonance Imaging. Arterioscler Thromb Vasc Biol 2018; 38:927-934. [PMID: 29472231 DOI: 10.1161/atvbaha.117.310296] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/07/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Early atherosclerosis is often undetected due in part to compensatory enlargement of the outer wall, termed positive remodeling. Variations in hemodynamic conditions and clinical factors influence the patterns of remodeling. The carotid artery provides an opportunity to examine these variations because of the unique geometry of the carotid bulb. This study aimed to determine differences in remodeling of the common, internal, and bifurcation segments of the carotid using magnetic resonance imaging. APPROACH AND RESULTS Carotid arteries of 525 subjects without history of cardiovascular disease were imaged by magnetic resonance imaging. The carotid artery was divided into 3 segments: common carotid artery; bifurcation; and internal carotid artery. Remodeling patterns were characterized using linear regression analysis of lumen and total vessel areas (dependent variables) compared with maximum wall thickness (independent variable) for each segment, adjusted for age, sex, and height. The common carotid artery demonstrated a pattern consistent with positive remodeling, whereas the bifurcation demonstrated negative remodeling. The internal carotid artery demonstrated a mixed pattern of outer wall expansion and lumen constriction. Females and subjects with diabetes mellitus showed more positive remodeling, hypertension was associated with attenuated positive remodeling, and those with hypercholesterolemia showed more negative remodeling. CONCLUSIONS In this cohort of 55- to 80-year-old individuals without history of cardiovascular disease, the pattern of early carotid artery remodeling was segment specific and appeared to be associated with sex and clinical characteristics. These findings provide the groundwork for longitudinal studies to define local and systemic factors such as hemodynamic and clinical conditions on carotid artery remodeling.
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Affiliation(s)
- Hiroko Watase
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Jie Sun
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Daniel S Hippe
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Niranjan Balu
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Feiyu Li
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Xihai Zhao
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Venkatesh Mani
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Zahi A Fayad
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Valentin Fuster
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Thomas S Hatsukami
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.)
| | - Chun Yuan
- From the Department of Surgery (H.W., T.S.H.) and Department of Radiology (J.S., D.S.H., N.B., C.Y.), University of Washington, Seattle; Department of Radiology, Peking University First Hospital, Beijing, China (F.L.); Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z.); Translational and Molecular Imaging Institute (V.M., Z.A.F.) and Cardiovascular Institute (V.F.), Icahn School of Medicine at Mount Sinai, New York; and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (V.F.).
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Watase H, Gao P, Sui B, Shen M, Balu N, Zhao X, Li R, Sun J, Hippe DS, Jarvik GP, Yuan C, Hatsukami TS. Abstract WP135: Location and Composition of Extracranial Carotid and Intracranial Atheroma in Symptomatic U.S. and Chinese Patients Detected by Vessel Wall Magnetic Resonance Imaging. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp135] [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: 11/16/2022]
Abstract
Introduction:
Atherosclerosis of the extracranial carotid and intracranial arteries is an important contributor to stroke. Autopsy studies suggest that the location and components of atheroma may vary between different ethnic groups. Advances in cerebrovascular vessel wall imaging with 3D-magnetic resonance imaging (MRI) have provided a critical tool to assess these differences
in vivo
.
Hypothesis:
We tested the hypothesis that carotid culprit plaques are more common in U.S. patients, and that intracranial culprit plaques are more common in Chinese patients.
Methods:
As part of the ongoing Culprit Plaque in Acute Cerebral Infarction study, patients with acute anterior circulation ischemic stroke were recruited at the University of Washington and the Beijing Tiantan Hospital. Plaque presence, location, and composition (intraplaque hemorrhage [IPH], lipid core, calcification, disrupted luminal surface [DLS]) in the carotid and intracranial arteries on the symptomatic side were evaluated using a 3D multi-contrast vessel wall MRI protocol. Carotid and intracranial arteries were reviewed independently by an experienced reader blinded to clinical characteristics and ethnic group.
Results:
Twenty patients from the U.S. (median age: 59 years; 65% male) and 26 patients from China (58 years; 69% male) were evaluated. Of those, 18 U.S. patients (90%) and 20 Chinese patients (77%) had at least one plaque in either the carotid or intracranial arteries (p=0.4). Of those with plaque, 17 U.S. (94%) and 12 Chinese (60%) patients had carotid artery plaques (p= 0.02), and 11 U.S. (61%) and 19 Chinese (95%) patients had intracranial artery plaques (p=0.02). Features of possible culprit plaque (IPH and/or DLS) in the carotid artery were found in 8 U.S. patients (47%) but only 1 Chinese patient (8%) (p=0.04). Plaque composition in intracranial arteries was not significantly different between the two groups.
Conclusion:
Possible culprit plaques in the carotid artery were more common in symptomatic U.S. patients than Chinese patients, while intracranial plaques were more common in the Chinese patients. Accurate localization of the culprit plaque has important implications for treatment.
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Affiliation(s)
| | - Peiyi Gao
- Dept of Radiology, Beijing Tiantan Hosp, Capital Med Univ; Beijing Neurosurgical Institute, Beijing, China
| | - Binbin Sui
- Dept of Radiology, Beijing Tiantan Hosp, Capital Med Univ; Beijing Neurosurgical Institute, Beijing, China
| | - Mi Shen
- Dept of Radiology, Beijing Tiantan Hosp, Capital Med Univ; Beijing Neurosurgical Institute, Beijing, China
| | | | - Xihai Zhao
- Dept of Biomedical Engineering, Tsinghua Univ, Beijing, China
| | - Rui Li
- Dept of Biomedical Engineering, Tsinghua Univ, Beijing, China
| | - Jie Sun
- Dept f Radiology, Univ of Washington, Seattle, WA
| | | | - Gail P Jarvik
- Depts of Medicine (Med Genetics) and Genome Sciences, Univ of Washington, Seattle, WA
| | - Chun Yuan
- Dept of Radiology, Univ of Washington, Seattle, WA
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50
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Sun J, Gao H, Balu N, Hippe D, Yuan C, Hatsukami T. Abstract WP112: Association and Discordance Between Magnetic Resonance Angiography and Three-Dimensional Vessel Wall Imaging in Detecting Intracranial Atherosclerosis. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.wp112] [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: 11/16/2022]
Abstract
Background:
Evaluation of intracranial atherosclerosis currently relies on angiography techniques to detect luminal stenosis, among which 3D time-of-flight (TOF) MRA is most widely used. Recently, 3D vessel wall (VW) MRI has allowed direct plaque visualization in major intracranial arteries.
Purpose:
We sought to study the association between luminal stenosis on TOF-MRA and plaque on VW-MRI in major intracranial arteries.
Methods:
Patients with recent cerebral ischemic events and without cardioembolic or rare etiologies were scanned with intracranial TOF-MRA (resolution: 0.53x0.83x1.4 mm
3
) and VW-MRI (0.8x0.8x0.8 mm
3
). Eleven segments were evaluated, including cavernous and supraclinoid internal carotid artery (ICA), anterior cerebral artery (A1), middle cerebral artery (M1), basilar artery, and posterior cerebral artery (P1). TOF-MRA and VW-MRI were analyzed blinded to each other and clinical data. Luminal stenosis on TOF-MRA was categorized as mild (1-49%), moderate (50-69%), severe (70-99% or flow void), and occlusion (100%). Plaque on VW-MRI was defined as focal wall thickening that exceeded twice reference wall thickness, with plaque burden measured as 1 - lumen diameter / outer wall diameter at the level of maximum wall thickness.
Results:
Nineteen patients were recruited (59.4±14.3 years; 68.4% male). TOF-MRA detected stenosis in 28 segments while VW-MRI detected plaque in 88 segments. Sixty-three (71.6%) plaques on VW-MRI did not show luminal stenosis on TOF-MRA, which, compared to those showing luminal stenosis on TOF-MRA, had smaller plaque burden (0.48±0.09 vs. 0.58±0.11; p<0.001) and were more commonly localized in the supraclinoid ICA (p=0.029) and less likely in the A1 segment (p=0.043). Three (2 mild; 1 moderate) stenoses on TOF-MRA did not show plaque on VW-MRI. TOF-MRI and VW-MRI had a weak correlation both in detecting segmental atherosclerosis (Cohen’s kappa: 0.30 [0.20, 0.41]) and in evaluating lesion severity (stenosis vs. plaque burden; Spearman’s rho: 0.44 [0.25, 0.60]).
Conclusions:
In symptomatic patients, segmental atherosclerosis was three times more prevalent on VW-MRI than TOF-MRA. Further studies are warranted to understand the clinical implications of VW-MRI plaques that are undetected on TOF-MRA.
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Affiliation(s)
- Jie Sun
- Radiology, Univ of Washington, Seattle, WA
| | - Haifeng Gao
- Neurology, Tangshan Gongren Hosp, Tangshan, China
| | | | | | - Chun Yuan
- Radiology, Univ of Washington, Seattle, WA
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