In vivo noninvasive detection and age definition of arterial thrombus by MRI

Corti, Roberto; Osende, Julio I.; Fayad, Zahi A.; Fallon, John T.; Fuster, Valentín; Mizsei, Gabor; Dickstein, Elisha; Drayer, Burton P.; Badimón, Juan J.

doi:10.1016/s0735-1097(02)01754-0

Cited by 112 publications

(85 citation statements)

References 29 publications

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“…Recent studies have used multicontrast MRI to identify fibrous cap rupture, which is also capable of stratifying plaque into complicated and noncomplicated subtypes. 23,24 Recent animal experiments have also shown the ability of MRI to accurately identify and age intraluminal 14 thrombus and that arising from induced plaque rupture. 25 …”

Section: Relationship To Other Workmentioning

confidence: 99%

Characterization of Complicated Carotid Plaque With Magnetic Resonance Direct Thrombus Imaging in Patients With Cerebral Ischemia

Moody¹,

Murphy²,

Morgan³

et al. 2003

Circulation

414

308

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Background-Thromboembolic disease secondary to complicated carotid atherosclerotic plaque is a major cause of cerebral ischemia. Clinical management relies on the detection of significant (Ͼ70%) carotid stenosis. A large proportion of patients suffer irreversible cerebral ischemia as a result of lesser degrees of stenosis. Diagnostic techniques that can identify nonstenotic high-risk plaque would therefore be beneficial. High-risk plaque is defined histologically if it contains hemorrhage/thrombus. Magnetic resonance direct thrombus imaging (MRDTI) is capable of detecting methemoglobin within intraplaque hemorrhage. We assessed this as a marker of complicated plaque and compared its accuracy with histological examination of surgical endarterectomy specimens. Methods and Results-Sixty-three patients underwent successful MRDTI and endarterectomy with histological examination. Of these, 44 were histologically defined as complicated (type VI plaque). MRDTI demonstrated 3 false-positive and 7 false-negative results, giving a sensitivity and specificity of 84%, negative predictive value of 70%, and positive predictive value of 93%. The interobserver (ϭ0.75) and intraobserver (ϭ0.9) agreement for reading MRDTI scans was good. Conclusions-MRDTI of the carotid vessels in patients with cerebral ischemia is an accurate means of identifying histologically confirmed complicated plaque. The high contrast generated by short T 1 species within the plaque allows for ease of interpretation, making this technique highly applicable in the research and clinical setting for the investigation of carotid atherosclerotic disease. Key Words: thrombus Ⅲ plaque Ⅲ carotid arteries Ⅲ imaging Ⅲ cerebral ischemia A therothrombotic carotid disease is a major cause of cerebral ischemia. Embolization from the surface of an atherosclerotic plaque to cerebral vessels can result in occlusion, which, if sufficiently prolonged, will result in cerebral infarction. More transient vascular occlusion may result in temporary ischemia, producing a neurological deficit that recovers with little or no residual brain damage. Clinically, transient ischemic attacks (TIAs) provide a warning of further cerebral ischemic events; Ϸ10% of patients who sustain a TIA, left untreated, will suffer a definitive stroke in the following year, 1 followed by a rate of 5% per annum. A warning TIA therefore offers the chance to intervene to prevent future permanent cerebral damage. The North American 2 and European 3 endarterectomy trials have both shown the positive benefit of surgery in patients with significant stenosis. The trials also indicate that lesser degrees of carotid disease are responsible for a significant number of strokes, but the risks of surgery matched or outweighed the benefits. Techniques have been sought to further define those among the group with moderate stenosis who are at high risk.In 1995, Stary et al, 4 for the American Heart Association, defined different atherosclerotic subtypes, the purpose being to pathologically identify plaque more likely to ...

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Section: Relationship To Other Workmentioning

confidence: 99%

Characterization of Complicated Carotid Plaque With Magnetic Resonance Direct Thrombus Imaging in Patients With Cerebral Ischemia

Moody¹,

Murphy²,

Morgan³

et al. 2003

Circulation

414

308

View full text Add to dashboard Cite

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“…18 -20 However, in animal experiments, MRI has accurately identified and aged intra-arterial lumen thrombus. 21,22 Recent work with multispectral MRI identified intraplaque hemorrhage and necrotic core with high accuracy in 18 human carotid endarterectomy subjects. 23 Later work has demonstrated that in vivo high resolution multicontrast MRI is capable of classifying intermediate to advanced atherosclerotic lesions in the human carotid artery and found a 37% prevalence of histological complicated (type VI) plaque in 52 preendarterectomy patients.…”

Section: Relationship To Other Workmentioning

confidence: 99%

Prevalence of Complicated Carotid Atheroma as Detected by Magnetic Resonance Direct Thrombus Imaging in Patients With Suspected Carotid Artery Stenosis and Previous Acute Cerebral Ischemia

Murphy¹,

Moody²,

Morgan³

et al. 2003

Circulation

153

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Background-It is recognized that complicated plaque largely accounts for the morbidity and mortality from atherosclerosis. Ideally, investigation of symptomatic and asymptomatic patients would identify atheromatous plaques independently of stenosis. We have previously shown that a magnetic resonance direct thrombus imaging (MRDTI) technique demonstrates complicated atheroma as high signal within the carotid arterial wall. We used this technique to examine the prevalence of complicated carotid plaque in vivo in the ipsilateral arteries of recently symptomatic patients with suspected carotid artery stenosis and to compare this with their contralateral arteries and with those of healthy age-and sex-matched controls. Methods and Results-The carotid arteries of 120 patients with suspected severe carotid artery stenosis and previous acute cerebral ischemia were imaged using MRDTI, as were 28 control arteries. High signal was not seen in any control artery. However, there was a 60% prevalence of high signal, suggestive of complicated plaque in the patients' ipsilateral arteries. The prevalence of high signal was significantly greater in the patients' ipsilateral vessels compared with the contralateral, asymptomatic side (60% versus 36%, 2 PϽ0.001), particularly for vessels of only moderate stenosis. Conclusions-MRDTI high signal suggestive of complicated plaque is prevalent in the ipsilateral carotid arteries of patients with carotid stenosis and recent cerebral ischemic events. MRDTI has a potential role in identifying "at risk" plaque, studying atherogenesis and the effects of plaque-modifying strategies. (Circulation. 2003;107:3053-3058.)

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“…Semi-quantitative comparison of the MR images to immunohistochemical staining of the same thrombus (Fig. 2d-g) show that bright regions in MR images correspond to laminations of coalescent platelets mixed with fibrin meshwork, known as Zahn lines (10,11,18,19). Such bright patterns in T 1 -weighted MR images, as in the example in Figure 2, were found in 18 of 21 samples.…”

Section: Resultsmentioning

confidence: 76%

An MRI study of the differences in the rate of thrombolysis between red blood cell‐rich and platelet‐rich components of venous thrombi ex vivo

Vidmar

Blinc

Kralj³

et al. 2011

Magnetic Resonance Imaging

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Purpose: To test whether T 1 -weighted MRI can detect the differences in the rate of thrombolysis induced by recombinant tissue plasminogen activator (rt-PA) between platelet-rich regions and red blood cell (RBC)-rich regions of venous thrombi ex vivo. Materials and Methods:Each of 21 venous thrombi ex vivo (8 pulmonary emboli and 13 in situ thrombi) was dissected along the longitudinal axis. Half of it was analyzed for the presence of platelet, fibrin, and RBC components by immunohistochemistry and the other half was imaged serially by high-resolution T 1 -weighted three-dimensional MRI to assess the progression of thrombolysis. The MR images were analyzed for proportions of the remaining platelet-rich and RBC-rich regions.Results: Laminated platelet-rich regions, corresponding to Zahn lines, were confirmed immunohistochemically and by MRI in 18/21 venous thrombi. In T 1 -weighted MR images (TE/TR ¼ 10/105 ms) the mean signal intensity of platelet-rich regions was on average 2.3 higher than that of RBC-rich regions. The rate of thrombolysis in plateletrich regions was on average 30% lower than in RBC-rich regions. After 120 min of thrombolysis the proportion of lysed platelet-rich regions was 0.27 6 0.04 versus 0.40 6 0.08 in RBC regions, which resulted in 1.4% decrease of lysed thrombus volume per 1% increase of platelet-rich content.Conclusion: Venous thrombi are most often composed of interspersed platelet-rich and RBC-rich regions. T 1 -weighted MRI is capable of noninvasive discrimination between those two components of venous thrombi ex vivo which have a different susceptibility to thrombolysis by rt-PA.

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In vivo noninvasive detection and age definition of arterial thrombus by MRI

Abstract: Magnetic resonance imaging is a promising tool to noninvasively detect arterial thrombosis. Measurement of SI and the characteristic visual appearance of the thrombus have the potential to define thrombus age.

Cited by 112 publications

References 29 publications

Characterization of Complicated Carotid Plaque With Magnetic Resonance Direct Thrombus Imaging in Patients With Cerebral Ischemia

Characterization of Complicated Carotid Plaque With Magnetic Resonance Direct Thrombus Imaging in Patients With Cerebral Ischemia

Prevalence of Complicated Carotid Atheroma as Detected by Magnetic Resonance Direct Thrombus Imaging in Patients With Suspected Carotid Artery Stenosis and Previous Acute Cerebral Ischemia

An MRI study of the differences in the rate of thrombolysis between red blood cell‐rich and platelet‐rich components of venous thrombi ex vivo

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