MRI plaque imaging reveals high-risk carotid plaques especially in diabetic patients irrespective of the degree of stenosis

Esposito, L.; Saam, Tobias; Heider, P.; Bockelbrink, Angelina; Pelisek, Jaroslav; Sepp, Dominik; Feurer, Regina; Winkler, C; Liebig, Thomas; Holzer, Katrin; Pauly, Olivier; Sadikovic, Suwad; Hemmer, Bernhard; Poppert, Holger

doi:10.1186/1471-2342-10-27

Cited by 41 publications

(30 citation statements)

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“…Retrospective studies have already shown a relation between MRI-detected unstable plaque lesions and recent neurological symptoms [22]. In a previous study we found MRI-defined unstable carotid plaques to be clearly overrepresented in patients with symptomatic carotid artery stenosis [23] and especially in diabetic patients [24].…”

Section: Introductionmentioning

confidence: 82%

“…Independent data safety monitoring was provided by the local clinical study center (Münchner Studienzentrum) at the Technische Universität München. Patient data were partially acquired from a pooled data set of patients undergoing MRI plaque imaging [23], [24], [26]. The methods used in the study were in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…According to our previously published protocol, four contrast-weighted images were obtained as follows [23], [24], [26]: three-dimensional time-of-flight MR-angiography (3D TOF), T1-weighted (T1w), T2-weighted (T2w), and proton-density-weighted (PDw) studies of both carotid arteries. The MRI scan was centered on the carotid bifurcation on the side of the stenosis to assure proper matching between the contrast-weighted imaging series of each patient.…”

Section: Methodsmentioning

confidence: 99%

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MRI Plaque Imaging Detects Carotid Plaques with a High Risk for Future Cerebrovascular Events in Asymptomatic Patients

Esposito-Bauer

Saam²,

Ghodrati

et al. 2013

PLoS ONE

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PurposeThe aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I–VIII). Within these lesion types, lesion types IV–V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones.MethodsEighty-three consecutive patients (45 male (54.2%); age 54–88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50–99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I–VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance.ResultsSix out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months.During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV–V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV–V and VI) (log rank test P<0.0001).ConclusionsMRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.

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Section: Introductionmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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MRI Plaque Imaging Detects Carotid Plaques with a High Risk for Future Cerebrovascular Events in Asymptomatic Patients

Esposito-Bauer

Saam²,

Ghodrati

et al. 2013

PLoS ONE

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“…56 In a large MRI plaque imaging study involving 191 patients, moderate to high-grade carotid artery stenoses and advanced lesion phenotypes were over-represented in of T2D patients (57%), and multiple logistic regression analysis revealed association between T2D and MRI-defined high-risk lesion types (OR 2.59; 95% CI [1.15–5.81]), independent of the degree of stenosis. 57 …”

Section: Plaque Composition and Risk Of Carotid Artery Disease In Diamentioning

confidence: 99%

Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus

Yahagi

Kolodgie

Lutter

et al. 2017

ATVB

413

315

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The continuing increase in the prevalence of diabetes in the general population is predicted to result in a higher incidence of cardiovascular disease. Although the mechanisms of diabetes associated progression of atherosclerosis are not fully understood, at clinical and pathological level, there is an appreciation of increased disease burden and higher levels of arterial calcification in these subjects. Plaques within the coronary arteries of patients with diabetes generally exhibit larger necrotic cores and significantly greater inflammation consisting mainly of macrophages and T lymphocytes relative to patients without diabetes. Moreover, there is a higher incidence of healed plaque ruptures and positive remodeling in hearts from subjects with type 1 diabetes (T1D) and type 2 diabetes (T2D), suggesting a more active atherogenic process. Lesion calcification in the coronary, carotid and other arterial beds is also more extensive. While the role of coronary artery calcification in identifying cardiovascular disease and predicting its outcome is undeniable, our understanding of how key hormonal and physiological alterations associated with diabetes such as insulin resistance and hyperglycemia influence the process of vascular calcification continues to grow. Important drivers of atherosclerotic calcification in diabetes include oxidative stress, endothelial dysfunction, alterations in mineral metabolism, increased inflammatory cytokine production, and release of osteoprogenitor cells from the marrow into the circulation. Our review will focus on the pathophysiology of T1D- and T2D-associated vascular disease with particular focus on coronary and carotid atherosclerotic calcification.

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“…[1] study also observed an association between diabetes and the prevalence of distal embolization in the cerebral vasculature after carotid endarterectomy, suggesting the hypothesis that the presence of diabetes might have clinical implications for the treatment of carotid disease. Several cautionary points should be noted in the interpretation of these results.…”

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confidence: 95%

MRI plaque imaging and its role in population-based studies

Yuan

Berry

2010

BMC Med

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Noninvasive direct vessel wall (plaque) imaging may provide a good opportunity to study unique aspects of atherosclerotic lesions in different populations. The article published by Esposito et al. provides new insights into our understanding of diabetic atherosclerotic vascular disease by using direct plaque imaging techniques. The findings from this article call for attention to more in vivo imaging to understand the nature of high-risk atherosclerosis, especially in prospective studies in diabetic patients.See research article: http://www.biomedcentral.com/1471-2342/10/27/abstract

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MRI plaque imaging reveals high-risk carotid plaques especially in diabetic patients irrespective of the degree of stenosis

Cited by 41 publications

References 37 publications

MRI Plaque Imaging Detects Carotid Plaques with a High Risk for Future Cerebrovascular Events in Asymptomatic Patients

MRI Plaque Imaging Detects Carotid Plaques with a High Risk for Future Cerebrovascular Events in Asymptomatic Patients

Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus

MRI plaque imaging and its role in population-based studies

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