Atherosclerosis Imaging Using MR Imaging: Current and Emerging Applications

Desai, Milind Y.; Bluemke, David A.

doi:10.1016/j.mric.2004.12.005

Cited by 6 publications

(5 citation statements)

References 70 publications

(96 reference statements)

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“…Over half of these deaths were due to coronary disease, which is primarily diagnosed by X-ray angiography. Researchers are investigating use of MRI angiography as a nonionizing alternative (1,2). Nontargeted roentgen graphic visualization of the blood vessels after injection of a radioopaque substance, or MR angiogram with blood pool contrast agents, can reveal only the vessel lumen and silhouette of lesions that impinge upon the lumen (3).…”

Section: Introductionmentioning

confidence: 99%

Development of Contrast Agents Targeted to Macrophage Scavenger Receptors for MRI of Vascular Inflammation

2006

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Atherosclerosis is a leading cause of death in the U.S. Because there is a potential to prevent coronary and arterial diseases through early diagnosis, there is a need for methods to image arteries in the subclinical stage as well as clinical stage using various non-invasive techniques, including Magnetic Resonance Imaging (MRI). We describe a development of a novel MRI contrast agent targeted to plaques that will allow imaging of lesion formation. The contrast agent is directed to macrophages, one of the earliest components of developing plaques. Macrophages are labeled through the macrophage scavenger receptor A, a macrophage specific cell surface protein, using an MRI contrast agent derived from scavenger receptor ligands. We have synthesized and characterized these contrast agents with a range of relaxivities. In vitro studies show that the targeted contrast agent accumulates in macrophages and solution studies indicate that micromolar concentrations are sufficient to produce contrast in an MR image. Cell toxicity and initial biodistribution studies indicate low toxicity, no detectable retention in normal blood vessels, and rapid clearance from blood. The promising performance of this contrast agent targeted towards vascular inflammation opens doors to tracking of other inflammatory diseases such as tumor immunotherapy and transplant acceptance using MRI.

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Section: Introductionmentioning

confidence: 99%

Development of Contrast Agents Targeted to Macrophage Scavenger Receptors for MRI of Vascular Inflammation

2006

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“…29 Among the various MRI techniques used to quantify plaque size, plaque volume has better measurement reproducibility than plaque thickness or area. 30 The enhanced reproducibility and smaller measurement variability have been suggested by some to allow MRI trials to have even smaller sample sizes and potentially shorter trial durations. 29 In addition to analyzing plaque progression versus regression, MRI allows for characterization of plaque composition (ie, differentiating fibrous cap from lipid core).…”

Section: Atherosclerosis Imaging In Clinical Trialsmentioning

confidence: 99%

Adjunctive Lipid Lowering Therapy in the Era of Surrogate Endpoints

Silverman

Blaha²,

Blumenthal³

2011

Cardiology in Review

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Statins have been shown to reduce cardiovascular events. However, despite widespread use of statin therapy, residual cardiovascular risk remains, and this has left clinicians searching for an effective adjunctive therapy to optimize lipid profiles and reduce risk further. Given the cost and duration of large event driven trials, adjunctive lipid lowering therapy options have largely been evaluated through surrogate measures of atherosclerosis, making clinical practice decisions regarding combination therapy difficult. Two common approaches that have been evaluated almost entirely by surrogate outcome trials include the addition of ezetimibe or the addition of niacin. Our article attempts to place these surrogate end point trials in their proper context, providing clinicians with a practical approach to making clinical practice decisions regarding adjunctive therapy in the absence of clinical outcomes data. Although definitive changes to lipid lowering guidelines should be based on clinical outcomes trials, in the absence of clinical outcomes data, it is reasonable to make individualized clinical practice decisions on the basis of surrogate measures of disease as long as there is corroboration among the effect on atherosclerosis and lipid parameters as adjunctive therapy, and clinical outcomes as monotherapy. Given that niacin fits these criteria, it seems prudent to support the use of niacin as adjunctive therapy in combination with maximally tolerated dose of statin in patients with low high-density lipoprotein-cholesterol and known coronary artery disease. Three ongoing clinical outcomes trials evaluating niacin and ezetimibe in combination with statin will provide more definitive word regarding the safety and efficacy of these agents as adjunctive therapy.

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“…CMR has been used to assess atherosclerotic disease progression in the carotid arteries, aorta, and coronary arteries 17. The technique also provides detailed information about plaque composition, which may eventually play a role in predicting plaque vulnerability to rupture 18.…”

Section: Cimt Versus Other Imaging Measuresmentioning

confidence: 99%

Clinical and Research Applications of Carotid Intima-Media Thickness

Sharma

Blaha

Blumenthal

et al. 2009

The American Journal of Cardiology

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Cardiovascular imaging modalities such as coronary computed tomography, carotid ultrasonography, and cardiovascular magnetic resonance imaging are increasingly being utilized to measure cardiovascular disease progression. Imaging measures, most notably carotid intima-media thickness (CIMT), are being applied as surrogate markers for clinical endpoints such as myocardial infarction and death in clinical trials. Clinicians and their patients are faced with the challenge of evaluating these imaging measures for their efficacy and practicality in clinical practice, as well as in clinical trials. We conclude from a review of clinical trials and guidelines that CIMT measurement may be useful in evaluating cardiovascular disease risk in select patient populations but may not always be an appropriate surrogate for clinical endpoints. While CIMT has clear advantages over alternative cardiovascular imaging modalities, ultimately prospective trials comparing the effectiveness of CIMT as a predictive tool of cardiovascular risk with that of other novel markers would best direct clinical recommendations for this imaging measure.

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Atherosclerosis Imaging Using MR Imaging: Current and Emerging Applications

Cited by 6 publications

References 70 publications

Development of Contrast Agents Targeted to Macrophage Scavenger Receptors for MRI of Vascular Inflammation

Development of Contrast Agents Targeted to Macrophage Scavenger Receptors for MRI of Vascular Inflammation

Adjunctive Lipid Lowering Therapy in the Era of Surrogate Endpoints

Clinical and Research Applications of Carotid Intima-Media Thickness

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