Imaging of Vulnerable Plaques Using Near-Infrared Spectroscopy for Risk Stratification of Atherosclerosis

Sanon, Saurabh; Dao, Tim; Sanon, Vani P.; Chilton, Robert

doi:10.1007/s11883-012-0304-6

Cited by 11 publications

(6 citation statements)

References 31 publications

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“…Furthermore, the presence of lipid in the plaque is a driver of local inflammation (20) and altered gene expression (21). Because of these central roles, quantification of plaque lipid has been a key aim of various atherosclerosis imaging techniques such as intravascular ultrasound (22), near infrared spectroscopy (23), cardiac computed tomography (24), and vascular magnetic resonance imaging (11).…”

Section: Discussionmentioning

confidence: 99%

Quantification of Lipid-Rich Core in Carotid Atherosclerosis Using Magnetic Resonance T2 Mapping

Chai

Biasiolli

et al. 2017

JACC: Cardiovascular Imaging

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ObjectivesThe aim of this study was to: 1) provide tissue validation of quantitative T2 mapping to measure plaque lipid content; and 2) investigate whether this technique could discern differences in plaque characteristics between symptom-related and non–symptom-related carotid plaques.BackgroundNoninvasive plaque lipid quantification is appealing both for stratification in treatment selection and as a possible predictor of future plaque rupture. However, current cardiovascular magnetic resonance (CMR) methods are insensitive, require a coalesced mass of lipid core, and rely on multicontrast acquisition with contrast media and extensive post-processing.MethodsPatients scheduled for carotid endarterectomy were recruited for 3-T carotid CMR before surgery. Lipid area was derived from segmented T2 maps and compared directly to plaque lipid defined by histology.ResultsLipid area (%) on T2 mapping and histology showed excellent correlation, both by individual slices (R = 0.85, p < 0.001) and plaque average (R = 0.83, p < 0.001). Lipid area (%) on T2 maps was significantly higher in symptomatic compared with asymptomatic plaques (31.5 ± 3.7% vs. 15.8 ± 3.1%; p = 0.005) despite similar degrees of carotid stenosis and only modest difference in plaque volume (128.0 ± 6.0 mm3 symptomatic vs. 105.6 ± 9.4 mm3 asymptomatic; p = 0.04). Receiver-operating characteristic analysis showed that T2 mapping has a good ability to discriminate between symptomatic and asymptomatic plaques with 67% sensitivity and 91% specificity (area under the curve: 0.79; p = 0.012).ConclusionsCMR T2 mapping distinguishes different plaque components and accurately quantifies plaque lipid content noninvasively. Compared with asymptomatic plaques, greater lipid content was found in symptomatic plaques despite similar degree of luminal stenosis and only modest difference in plaque volumes. This new technique may find a role in determining optimum treatment (e.g., providing an indication for intensive lipid lowering or by informing decisions of stents vs. surgery).

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Section: Discussionmentioning

confidence: 99%

Quantification of Lipid-Rich Core in Carotid Atherosclerosis Using Magnetic Resonance T2 Mapping

Chai

Biasiolli

et al. 2017

JACC: Cardiovascular Imaging

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“…2,80 A number of studies have used IVUS-coupled virtual histology (IVUS-VH) to track changes in plaque composition over time with lipid lowering treatment. 81,82 Park et al 82 demonstrated in a recent randomized trial that rosuvastatin reduced per cent necrotic core volume from 21.3% to 18% over 12 month follow-up, whereas fibro fatty volume increased from 11.7% to 14.8% suggesting statin-induced change in plaque composition. To further enhance the sensitivity in detecting subtle plaque compositional changes, NIRS was recently developed.…”

Section: Invasive Coronary Imaging-from Lumen To Vessel Wallmentioning

confidence: 99%

Plaque imaging to refine indications for emerging lipid-lowering drugs

Alkhalil

Chai

Choudhury

2016

Eur Heart J Cardiovasc Pharmacother

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Statins have been effective in reducing adverse cardiovascular events. Their benefits have been proportional to the level of plasma LDL-cholesterol reduction and seem to extend to patients with 'normal' levels of cholesterol at outset. Statins are also inexpensive and have a favourable side-effect profile. As a result, they are used widely (almost indiscriminately) in patients with atherosclerotic vascular disease, and in those at risk of disease. Next generation lipid-modifying drugs seem unlikely to offer the same simplicity of application. The recent trials of new classes of lipid modifying drugs underline the need for a risk stratification tool which is not based on patients' category of diagnosis (for example, post-myocardial infarction) but based on the characterization of disease in that individual patient. Mechanistic staging, a process that matches the target of the drug action with an identifiable disease characteristic, may offer an opportunity to achieve more precise intervention. The upshots of this targeted approach will be greater efficacy, requiring smaller clinical trials to demonstrate effectiveness; a reduced number needed to treat to yield benefits and more cost-effective prescribing. This will be important, as purchasers require ever more rigorous demonstration of both efficacy and cost-effectiveness. In this context, we will discuss available pharmacological strategies of lipid reduction in anti-atherosclerotic treatment and how plaque imaging techniques may provide an ideal method in stratifying patients for new lipid-modifying drugs.

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“…For example, transesophageal US was recently employed in mongrel dogs to quantify changes in aortic area and elastic properties from velocity-vector imaging (VVI) with aging 80 . Another study used a combination of multi-vessel IVUS and novel near infra-red spectroscopy (NIRS) 81, 82 to evaluate features of vulnerability in fibroatheromas of diabetic/hypercholesterolemic pigs 83 . Longitudinally, IVUS demonstrated a progressive increase in plaque and media areas, with the appearance of necrotic cores and regions of positive vascular remodeling.…”

Section: Imagingmentioning

confidence: 99%