Objective To determine the association between the irregularity of carotid plaque surface using multidimensional magnetic resonance imaging(MRI) of ipsilateral acute cerebral infarction(ACI) cases. Methods Patients wi...Objective To determine the association between the irregularity of carotid plaque surface using multidimensional magnetic resonance imaging(MRI) of ipsilateral acute cerebral infarction(ACI) cases. Methods Patients with recent cerebrovascular symptoms(stroke or transient ischemic attack < 2 weeks) and atherosclerotic plaque in at least one carotid artery were diagnosed by B-mode ultrasound imaging(intima-media thickness ≥ 1.5 mm) and recruited for the present study. Irregular surface was defined when plaque surface was uneven with high and low fluctuation or plaque with surface ulceration. The irregularity of carotid plaque surface was determined on axial or oblique images alone(single-dimension) and on both axial images and oblique images(multidimensions), separately. Univariate and multivariate logistic regression analyses were performed to calculate the odds ratio(OR) and the corresponding 95% CI of the irregular plaque surface in discriminating the presence of ipsilateral ACI. Results A total of 217 included subjects(mean age: 60.7 ± 10.2 years, 149 men) were recruited and 89(41.0%), 88(40.6%) and 118(54.4%) of them exhibited irregular plaque surface on axial, oblique and multidimensional MR images, respectively. The OR of irregularity of the plaque surface was determined by multidimensional MRI to be 5.88(95% CI: 3.16–10.96, P < 0.001) in discriminating the presence of ipsilateral ACI. Following adjustment for clinical confounding factors, this association remained statistically significant(OR = 5.65, 95% CI: 2.53–12.60, P < 0.001). The analysis included further adjustment for the presence of lipid-rich necrotic core, intraplaque hemorrhage and stenosis and the results included that this association also remained statistically significant(OR = 6.08, 95% CI: 2.52–14.68, P < 0.001). Conclusions The irregular plaque surface was determined by multidimensional MRI as an independent indicator for ipsilateral acute cerebral infarction.展开更多
Objective To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis.Methods Elderly patients(>60 years)with moderate to ...Objective To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis.Methods Elderly patients(>60 years)with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups,and underwent magnetic resonance imaging and computed tomography imaging.The carotid plaque features including lipid-rich necrotic core,intraplaque hemorrhage,calcification,and fibrous cap rupture(FCR)were evaluated,and maximum wall thickness,normalized wall index(NWI),and luminal stenosis were measured.The association between these variables and collateral circulation status was analyzed.Results Of the 97 patients(78 males,mean age:69.0±6.1 years),19(19.6%)had poor collaterals.The poor collateral group had a significantly higher NWI(93.7%±5.0%vs.89.0%±7.9%,P=0.011),a greater extent of stenosis(80.0%±11.4%vs.75.3%±9.4%,P=0.036)and FCR(84.2%vs.55.1%,P=0.020)compared with good collateral group.Carotid NWI(OR=3.83,95%CI:1.36–10.82,P=0.011)and more FCR(OR=6.77,95%CI:1.35–33.85,P=0.020)were associated with poor collateral circulation after adjustment for the confounding factors.The combination of NWI,FCR,systolic blood pressure,and triglycerides had the highest area-under-the-curve(AUC=0.85)for detection of poor collaterals.Conclusions Carotid plaque features,specifically NWI and FCR,are independently associated with poor collateral circulation,and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.展开更多
Background Wall shear stress is an important factor in the destabilization of atherosclerotic plaques. The purpose of this study was to assess the distribution of wall shear stress in advanced carotid plaques using hi...Background Wall shear stress is an important factor in the destabilization of atherosclerotic plaques. The purpose of this study was to assess the distribution of wall shear stress in advanced carotid plaques using high resolution magnetic resonance imaging and computational fluid dynamics.Methods Eight diseased internal carotid arteries in seven patients were evaluated. High resolution magnetic resonance imaging was used to visualize the plaque structures, and the mechanic stress in the plaque was obtained by combining vascular imaging post-processing with computational fluid dynamics.Results Wall shear stresses in the plaques in all cases were higher than those in control group. Maximal shear stresses in the plaques were observed at the top of plaque hills, as well as the shoulders of the plaques. Among them,the maximal shear stress in the ruptured plaque was observed in the rupture location in three cases and at the shoulder of fibrous cap in two cases. The maximal shear stress was also seen at the region of calcification, in thrombus region and in the thickest region of plaque in the other three cases, respectively.Conclusion Determination of maximal shear stress at the plaque may be useful for predicting the rupture location of the plaque and may play an important role in assessing plaque vulnerability.展开更多
AIM: To compare 3D Black Blood turbo spin echo(TSE)sampling perfection with application-optimized contrast using different flip angle evolution(SPACE) vs 2D TSE in evaluating atherosclerotic plaques in multiple vascul...AIM: To compare 3D Black Blood turbo spin echo(TSE)sampling perfection with application-optimized contrast using different flip angle evolution(SPACE) vs 2D TSE in evaluating atherosclerotic plaques in multiple vascular territories. METHODS: The carotid, aortic, and femoral arterial walls of 16 patients at risk for cardiovascular or atherosclerotic disease were studied using both 3D black blood magnetic resonance imaging SPACE and conventional 2D multi-contrast TSE sequences using a consolidated imaging approach in the same imaging session. Qualitative and quantitative analyses were performed on the images. Agreement of morphometric measurements between the two imaging sequences was assessed using a two-sample t-test, calculation of the intra-class correlation coefficient and by the method of linear regression and Bland-Altman analyses. RESULTS: No statistically significant qualitative differences were found between the 3D SPACE and 2D TSE techniques for images of the carotids and aorta. For images of the femoral arteries, however, there were statistically significant differences in all four qualitative scores between the two techniques. Using the current approach, 3D SPACE is suboptimal for femoral imaging. However, this may be due to coils not being optimized for femoral imaging. Quantitatively, in our study, higher mean total vessel area measurements for the 3D SPACE technique across all three vascular beds were observed. No significant differences in lumen area for both the right and left carotids were observed between the two techniques. Overall, a significant-correlation existed between measures obtained between the two approaches. CONCLUSION: Qualitative and quantitative measurements between 3D SPACE and 2D TSE techniques are comparable. 3D-SPACE may be a feasible approach in the evaluation of cardiovascular patients.展开更多
The assessment and management of early-stage atherosclerosis are important for the prevention of cardiovascular disease(CVD).In this study,we used multi-contrast magnetic resonance imaging(MRI) to investigate the caro...The assessment and management of early-stage atherosclerosis are important for the prevention of cardiovascular disease(CVD).In this study,we used multi-contrast magnetic resonance imaging(MRI) to investigate the carotid plaque feature in asymptomatic,at-risk subjects;we also evaluated the correlation between MRI findings and Framingham risk score(FRS).One hundred sixty-six asymptomatic individuals with risk factors for CVD underwent multi-contrast MRI.After the arterial morphology and plaque components were outlined,the differences in carotid plaque burden among the various risk categories were analyzed.The FRS analysis showed that high-risk individuals had thicker vessel wall and higher plaque lipid content than did low risk participants.A substantial proportion of advanced carotid plaques occurred in low and intermediate-risk groups.Multi-contrast MRI may provide incremental value to the FRS in managing asymptomatic at-risk population.展开更多
基金supported by the National Natural Science Foundation of China (No. 81771825)Beijing Municipal Science and Technology Commission (D1711000 03017003)Ministry of Science and Technology of China (2017YFC1307904)
文摘Objective To determine the association between the irregularity of carotid plaque surface using multidimensional magnetic resonance imaging(MRI) of ipsilateral acute cerebral infarction(ACI) cases. Methods Patients with recent cerebrovascular symptoms(stroke or transient ischemic attack < 2 weeks) and atherosclerotic plaque in at least one carotid artery were diagnosed by B-mode ultrasound imaging(intima-media thickness ≥ 1.5 mm) and recruited for the present study. Irregular surface was defined when plaque surface was uneven with high and low fluctuation or plaque with surface ulceration. The irregularity of carotid plaque surface was determined on axial or oblique images alone(single-dimension) and on both axial images and oblique images(multidimensions), separately. Univariate and multivariate logistic regression analyses were performed to calculate the odds ratio(OR) and the corresponding 95% CI of the irregular plaque surface in discriminating the presence of ipsilateral ACI. Results A total of 217 included subjects(mean age: 60.7 ± 10.2 years, 149 men) were recruited and 89(41.0%), 88(40.6%) and 118(54.4%) of them exhibited irregular plaque surface on axial, oblique and multidimensional MR images, respectively. The OR of irregularity of the plaque surface was determined by multidimensional MRI to be 5.88(95% CI: 3.16–10.96, P < 0.001) in discriminating the presence of ipsilateral ACI. Following adjustment for clinical confounding factors, this association remained statistically significant(OR = 5.65, 95% CI: 2.53–12.60, P < 0.001). The analysis included further adjustment for the presence of lipid-rich necrotic core, intraplaque hemorrhage and stenosis and the results included that this association also remained statistically significant(OR = 6.08, 95% CI: 2.52–14.68, P < 0.001). Conclusions The irregular plaque surface was determined by multidimensional MRI as an independent indicator for ipsilateral acute cerebral infarction.
基金supported by the National Natural Science Foundation of China(No.81771825)Peking University Third Hospital(BYSY2015013)+1 种基金Beijing Municipal Science and Technology Commission(D171100003017003)Ministry of Science and Technology of China(2017 YFC1307904).
文摘Objective To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis.Methods Elderly patients(>60 years)with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups,and underwent magnetic resonance imaging and computed tomography imaging.The carotid plaque features including lipid-rich necrotic core,intraplaque hemorrhage,calcification,and fibrous cap rupture(FCR)were evaluated,and maximum wall thickness,normalized wall index(NWI),and luminal stenosis were measured.The association between these variables and collateral circulation status was analyzed.Results Of the 97 patients(78 males,mean age:69.0±6.1 years),19(19.6%)had poor collaterals.The poor collateral group had a significantly higher NWI(93.7%±5.0%vs.89.0%±7.9%,P=0.011),a greater extent of stenosis(80.0%±11.4%vs.75.3%±9.4%,P=0.036)and FCR(84.2%vs.55.1%,P=0.020)compared with good collateral group.Carotid NWI(OR=3.83,95%CI:1.36–10.82,P=0.011)and more FCR(OR=6.77,95%CI:1.35–33.85,P=0.020)were associated with poor collateral circulation after adjustment for the confounding factors.The combination of NWI,FCR,systolic blood pressure,and triglycerides had the highest area-under-the-curve(AUC=0.85)for detection of poor collaterals.Conclusions Carotid plaque features,specifically NWI and FCR,are independently associated with poor collateral circulation,and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.
基金This work was supported by National Key Project of Scientific and Technical Supporting Programs Funded by Ministry of Science ＆ Technology of China During the l lth Five-year Plan （No. 2007BAI05B07）, Beijing Natural Science Foundation （No. 7002011） and Capital Medical Development and Research Foundation, China （No. 2005-2026）.
文摘Background Wall shear stress is an important factor in the destabilization of atherosclerotic plaques. The purpose of this study was to assess the distribution of wall shear stress in advanced carotid plaques using high resolution magnetic resonance imaging and computational fluid dynamics.Methods Eight diseased internal carotid arteries in seven patients were evaluated. High resolution magnetic resonance imaging was used to visualize the plaque structures, and the mechanic stress in the plaque was obtained by combining vascular imaging post-processing with computational fluid dynamics.Results Wall shear stresses in the plaques in all cases were higher than those in control group. Maximal shear stresses in the plaques were observed at the top of plaque hills, as well as the shoulders of the plaques. Among them,the maximal shear stress in the ruptured plaque was observed in the rupture location in three cases and at the shoulder of fibrous cap in two cases. The maximal shear stress was also seen at the region of calcification, in thrombus region and in the thickest region of plaque in the other three cases, respectively.Conclusion Determination of maximal shear stress at the plaque may be useful for predicting the rupture location of the plaque and may play an important role in assessing plaque vulnerability.
基金Supported by NIH NHLBI R01HL71021(Fayad ZA)and Siemens Medical Solutions
文摘AIM: To compare 3D Black Blood turbo spin echo(TSE)sampling perfection with application-optimized contrast using different flip angle evolution(SPACE) vs 2D TSE in evaluating atherosclerotic plaques in multiple vascular territories. METHODS: The carotid, aortic, and femoral arterial walls of 16 patients at risk for cardiovascular or atherosclerotic disease were studied using both 3D black blood magnetic resonance imaging SPACE and conventional 2D multi-contrast TSE sequences using a consolidated imaging approach in the same imaging session. Qualitative and quantitative analyses were performed on the images. Agreement of morphometric measurements between the two imaging sequences was assessed using a two-sample t-test, calculation of the intra-class correlation coefficient and by the method of linear regression and Bland-Altman analyses. RESULTS: No statistically significant qualitative differences were found between the 3D SPACE and 2D TSE techniques for images of the carotids and aorta. For images of the femoral arteries, however, there were statistically significant differences in all four qualitative scores between the two techniques. Using the current approach, 3D SPACE is suboptimal for femoral imaging. However, this may be due to coils not being optimized for femoral imaging. Quantitatively, in our study, higher mean total vessel area measurements for the 3D SPACE technique across all three vascular beds were observed. No significant differences in lumen area for both the right and left carotids were observed between the two techniques. Overall, a significant-correlation existed between measures obtained between the two approaches. CONCLUSION: Qualitative and quantitative measurements between 3D SPACE and 2D TSE techniques are comparable. 3D-SPACE may be a feasible approach in the evaluation of cardiovascular patients.
文摘The assessment and management of early-stage atherosclerosis are important for the prevention of cardiovascular disease(CVD).In this study,we used multi-contrast magnetic resonance imaging(MRI) to investigate the carotid plaque feature in asymptomatic,at-risk subjects;we also evaluated the correlation between MRI findings and Framingham risk score(FRS).One hundred sixty-six asymptomatic individuals with risk factors for CVD underwent multi-contrast MRI.After the arterial morphology and plaque components were outlined,the differences in carotid plaque burden among the various risk categories were analyzed.The FRS analysis showed that high-risk individuals had thicker vessel wall and higher plaque lipid content than did low risk participants.A substantial proportion of advanced carotid plaques occurred in low and intermediate-risk groups.Multi-contrast MRI may provide incremental value to the FRS in managing asymptomatic at-risk population.
