In Vivo 3D High-Spatial-Resolution MR Imaging of Intraplaque Hemorrhage

Bitar, Richard; Moody, Alan R.; Leung, General; Symons, Sean; Crisp, S.; Butany, Jagdish; Rowsell, Corwyn; Kiss, Alexander; Nelson, Andrew C.; Maggisano, Robert

doi:10.1148/radiol.2491071517

Cited by 106 publications

(80 citation statements)

References 24 publications

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“…We used the 3D-T1W fat suppresssed spoiled gradient echo or the 2D-T1W inversion recovery turbo field echo MR imaging sequence to detect intraplaque hemorrhage. Bitar et al 25 and Cappendijk et al 26 used sequences like ours and found a good sensitivity, specificity, and interobserver agreement for the detection of intraplaque hemorrhage in both sequences. They also found good agreement between MR imagingdepicted intraplaque hemorrhage and histologic sections.…”

Section: Discussionmentioning

confidence: 54%

“…20 Based on the good sensitivity and specificity of MDCTA for plaque ulcerations and the good agreement between MR imaging-depicted intraplaque hemorrhage and histology, we therefore conclude that it is legitimate to use imaging techniques such as MDCTA and MR imaging to study the relationship between intraplaque hemorrhage and the disruption of the plaque surface. 25,26 Moreover, the use of MDCTA and MR imaging provides the opportunity to investigate the relationship in a specific category of patients-that is, those with a mild-to-moderate carotid artery stenosis, patients who are treated medically and thus have no available histology. The final limitation of our study is that it is cross-sectional.…”

Section: Discussionmentioning

confidence: 99%

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Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK)

Dijk¹,

Truijman

Hussain³

et al. 2015

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK)

Dijk¹,

Truijman

Hussain³

et al. 2015

AJNR Am J Neuroradiol

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“…Nevertheless, the tissue thickness encompassed by imaging (mm) is different from the tissue thickness covered by immunohistochemistry (mm), and this difference is an inherent limitation of all such published studies (2)(3)(4)27). All published histologically validated carotid plaque studies have limitedsize populations, with heterogeneity in terms of symptoms, time to surgery, and medications (2)(3)(4)31), reflecting the logistic difficulties of these types of studies.…”

Section: Discussionmentioning

confidence: 99%

Investigating Vulnerable Atheroma Using Combined ¹⁸F-FDG PET/CT Angiography of Carotid Plaque with Immunohistochemical Validation

Menezes

Kotze²,

Agu³

et al. 2011

J Nucl Med

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Inflammation and angiogenesis are hypothesized to be important factors contributing to plaque vulnerability, whereas calcification is suggested to confer stability. To investigate this in vivo, we combined CT angiography and PET and compared the findings with immunohistochemistry for patients undergoing carotid endarterectomy. Methods: Twenty-one consecutive patients (18 men, 3 women; mean age 6 SD, 68.3 6 7.3) undergoing carotid endarterectomy were recruited for combined carotid 18 F-FDG PET/CT angiography. Plaque 18 F-FDG uptake was quantified with maximum standardized uptake value, and CT angiography quantified percentage plaque composition (calcium and lipid). Surgical specimens underwent ex vivo CT aiding image registration, followed by immunohistochemical staining for CD68 (macrophage density) and vascular endothelial growth factor (angiogenesis). Relationships between imaging and immunohistochemistry were assessed with Spearman rank correlation and multivariable regression. Results: The mean (6SD) surgically excised carotid plaque 18 F-FDG metabolism was 2.4 (60.5) versus 2.2 (60.3) contralaterally (P 5 0.027). There were positive correlations between plaque 18 F-FDG metabolism and immunohistochemistry with CD68 (r 5 0.55; P 5 0.011) and vascular endothelial growth factor (r 5 0.47; P 5 0.031). There was an inverse relationship between plaque 18 F-FDG metabolism and plaque percentage calcium composition on CT (r 5 20.51; P 5 0.018) and between calcium composition and immunohistochemistry with CD68 (r 5 20.57; P 5 0.007). Regression showed that maximum standardized uptake value and calcium composition were independently significant predictors of angiogenesis, and calcium composition was a predictor of macrophage density. Conclusion: We provide in vivo evidence that increased plaque metabolism is associated with increased biomarkers of angiogenesis and inflammation, whereas plaque calcification is inversely related to PET and histologic biomarkers of inflammation. The identification of atheroma at risk of causing cardiovascular events has been investigated for many years (1). The role of imaging in this respect has been 2-fold: first, to anatomically characterize atheroma with features of vulnerability, and second, to investigate key components of plaque pathogenesis such as inflammation and angiogenesis (2). PET (3,4) and dynamic MRI (5) have been used to image the latter, whereas high-resolution MRI (6) and CT (7,8) have been used to characterize plaque morphology. CT is particularly of interest because this is an ideal imaging modality for coronary arteries, and there is evidence that calcium composition predicts the likelihood of acute coronary syndromes (9).To synergistically image plaque vulnerability, it may be desirable to use a multimodality approach so that anatomy and pathophysiology may be assessed together. The value of such an approach has been shown in oncology (10) and cardiology (11). Indeed, this combined approach has now been applied to carotid plaque imaging (12,13). However, the finding...

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“…6,7 Magnetic resonance imaging (MRI) has emerged as a reliable and accurate tool for discriminating plaque components in vivo and for detecting IPH. 7,8 However, only few studies have investigated determinants of plaque composition in the carotid artery 9,10 and, specifically, studies relating risk factors to IPH are scarce. We recently reported that sex, age, smoking, and hypertension are associated with IPH in the general population.…”

mentioning

confidence: 99%

Blood Pressure Parameters and Carotid Intraplaque Hemorrhage as Measured by Magnetic Resonance Imaging

Selwaness¹,

Bouwhuijsen²,

Verwoert³

et al. 2013

Hypertension

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A therosclerotic plaques in the carotid arteries represent an important cause of cerebral ischemia. The composition of an atherosclerotic plaque is an important predictor for plaque rupture and subsequent thromboembolic events. Intraplaque hemorrhage (IPH) is considered as a high-risk component of the vulnerable plaque through contribution of cholesterol to the necrotic core of the plaque and by increasing macrophage infiltration, making the plaque more unstable. 1-3 Several studies have indicated a strong association of IPH with cerebrovascular events. [3][4][5] Furthermore, even in atherosclerotic lesions of asymptomatic subjects, IPH was shown to contribute to plaque progression and destabilization. 6,7 Magnetic resonance imaging (MRI) has emerged as a reliable and accurate tool for discriminating plaque components in vivo and for detecting IPH. 7,8 However, only few studies have investigated determinants of plaque composition in the carotid artery 9,10 and, specifically, studies relating risk factors to IPH are scarce. We recently reported that sex, age, smoking, and hypertension are associated with IPH in the general population. 11 Hypertension is a highly prevalent condition and a major contributor to atherosclerotic cardiovascular disease. However, the pathophysiology of the contribution of high blood pressure to atherosclerotic plaques is still not fully elucidated.For a long time, hemodynamic forces have been linked to atherosclerosis formation and plaque destabilization. 12 Plaque instability is, in part, determined by local factors, but it has been suggested that systemic factors are also important. 13 Atherosclerotic plaques form at positions of disturbed blood flow and concomitant low and oscillating wall shear stress, 14 whereas all structures of the arterial wall are influenced by blood pressure fluctuations.As a continuation of our previous study, 11 the current study was designed to determine the association of various blood pressure parameters with the presence of carotid IPH in a large population-based study.Abstract-Intraplaque hemorrhage (IPH) is a characteristic of the vulnerable atherosclerotic plaque that has been associated with ischemic stroke. Not much is known about determinants of IPH. We studied whether blood pressure parameters are associated with presence of IPH. Within the framework of a prospective population-based cohort study, The Rotterdam Study, the carotid arteries of 1006 healthy participants ≥45 years and with intima-media thickening (≥2.5 mm) on ultrasound were imaged with a 1.5-T magnetic resonance imaging scanner. IPH was defined as a hyperintense signal on a 3D-T1w-GRE magnetic resonance sequence. Generalized estimation equation analysis, adjusted for age, sex, carotid wall thickness, and cardiovascular risk factors, was used to assess the association between blood pressure parameters and IPH. Magnetic resonance imaging of the carotid arteries revealed presence of IPH in 444 of 1860 plaques (24%). Systolic blood pressure and pulse pressure (PP) were significantly asso...

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In Vivo 3D High-Spatial-Resolution MR Imaging of Intraplaque Hemorrhage

Abstract: With its high spatial resolution, MR imaging of IPH permits detection of plaque hemorrhage location, resulting in strong agreement between imaging and histologic findings.

Cited by 106 publications

References 24 publications

Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK)

Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK)

Investigating Vulnerable Atheroma Using Combined ¹⁸F-FDG PET/CT Angiography of Carotid Plaque with Immunohistochemical Validation

Blood Pressure Parameters and Carotid Intraplaque Hemorrhage as Measured by Magnetic Resonance Imaging

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In Vivo 3D High-Spatial-Resolution MR Imaging of Intraplaque Hemorrhage

Abstract: With its high spatial resolution, MR imaging of IPH permits detection of plaque hemorrhage location, resulting in strong agreement between imaging and histologic findings.

Cited by 106 publications

References 24 publications

Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK)

Intraplaque Hemorrhage and the Plaque Surface in Carotid Atherosclerosis: The Plaque At RISK Study (PARISK)

Investigating Vulnerable Atheroma Using Combined 18F-FDG PET/CT Angiography of Carotid Plaque with Immunohistochemical Validation

Blood Pressure Parameters and Carotid Intraplaque Hemorrhage as Measured by Magnetic Resonance Imaging

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Investigating Vulnerable Atheroma Using Combined ¹⁸F-FDG PET/CT Angiography of Carotid Plaque with Immunohistochemical Validation