Validity of Dual MRI and &lt;sup&gt;18&lt;/sup&gt;F-FDG PET Imaging in Predicting Vulnerable and Inflamed Carotid Plaque

Saito, Hisayasu; Kuroda, Satoshi; Hirata, Kenji; Magota, Keiichi; Shiga, Tohru; Tamaki, Nagara; Yoshida, Daisuke; Terae, Satoshi; Nakayama, Naoki; Houkin, Kiyohiro

doi:10.1159/000348846

Cited by 56 publications

(37 citation statements)

References 39 publications

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“…Prospective studies using these CT techniques to predict stroke risk are warranted now. Finally, the use of molecular and physiologic imaging with either radionuclides specific for plaque inflammation [98] or contrast-enhanced ultrasound [99] are emerging techniques that may also improve our ability to discriminate between high- and low-risk carotid plaques.…”

Section: Future Directions In Stroke Risk Assessment Studiesmentioning

confidence: 99%

Moving Beyond Luminal Stenosis: Imaging Strategies for Stroke Prevention in Asymptomatic Carotid Stenosis

Gupta¹,

Marshall

2015

Cerebrovasc Dis

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Background: With progressive improvements in medical therapy and resultant reductions in stroke risk, luminal stenosis criteria are no longer adequate to inform decisions to pursue surgical revascularization in patients with asymptomatic carotid artery stenosis. Summary: In this evidence-based review, we discuss the imaging-based risk stratification strategies that take into account factors beyond luminal stenosis measurements, including cerebral hemodynamics and plaque composition. The existing literature lends support to the use of certain imaging tests in patients with asymptomatic carotid stenosis including cerebrovascular reserve testing, MRI of plaque composition, ultrasound of plaque echolucency, and transcranial Doppler evaluation for microemboli. The highest quality evidence thus far in the literature includes only systematic reviews and meta-analyses of cohort studies with no randomized trials having yet been performed to show how these newer imaging biomarkers could be used to inform treatment decisions in asymptomatic carotid stenosis. Beyond the need for randomized trials, there are additional important steps needed to improve the relevance of evidence supporting risk assessment strategies. Imaging studies evaluating the risk of stroke in carotid disease should clearly define asymptomatic versus symptomatic disease, use uniform definitions of clearly defined outcome measures such as ipsilateral stroke, ensure that imaging interpretations are performed in a manner blinded to treatments and other risk factors, and include cohorts which are on modern intensive medical therapy. Such studies of risk stratification for asymptomatic carotid stenosis will be most valuable if they can integrate multiple high-risk features (including clinical risk factors) into a multi-factorial risk assessment strategy in a manner that is relatively simple to implement and generalizable across a wide range of practice settings. Key Messages: Together, modern imaging strategies allow for a more mechanistic assessment of stroke risk in carotid disease compared to luminal stenosis measurements alone, which, with further validation in randomized controlled trials, may improve current efforts at stroke prevention in asymptomatic carotid stenosis.

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Section: Future Directions In Stroke Risk Assessment Studiesmentioning

confidence: 99%

Moving Beyond Luminal Stenosis: Imaging Strategies for Stroke Prevention in Asymptomatic Carotid Stenosis

Gupta¹,

Marshall

2015

Cerebrovasc Dis

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“…In addition the observed coronary arteries are small [41]. The information contained in PET and MRI images is largely complementary, and their combination helps to predict plaque at high risk [42].…”

Section: Modality Combinationsmentioning

confidence: 99%

Multimodal Medical Image Fusion in Cardiovascular Applications

Pohl

Nazirun

Hamzah

et al. 2015

Lecture Notes in Bioengineering

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Recent publications in the field of medical image fusion point out the value of multi-modality in diagnosis, pre-surgical planning and surgical intervention. The integration of multiple data sources including medical images from different devices or sensors strongly increases reliability and information content. Successfully fused multi-modal data should not contain any artefacts, not remove any relevant information from the original data and minimize redundancy. Image and data fusion aims at providing supplementary clinical information that is not apparent in the individual images alone. Image and data fusion finds many different applications in the fields of remote sensing, military, biometrics, machine vision and medical imaging. The scientific community has established three levels of fusion rules, namely pixel, feature and decision level. Depending on the application, processing technique or available data each level has its importance and proven significance in medical data processing. Each level provides a set of rules that can be applied. The selection of the fusion operator has a strong impact on the quality of the result. It becomes apparent that the selection of level and technique must vary according to the information that needs to be extracted for a certain application. Each technique has its advantages and disadvantages which have to be carefully evaluated. Based on the availability of multimodal devices, such as ultrasound (US), magnetic resonance imaging (MRI) and computed tomography (CT), different images and data of the same object are obtained. The multiple images, the variety of fusion levels and rules lead to an uncountable number of possible combinations. This makes it very difficult for the user to select the most beneficial solution without losing valuable time and resources.

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“…MR imaging is time-consuming and limited by many contraindications, while CEUS might be limited by the occurrence of calcified plaques with subsequent acoustic shadowing. Ongoing work concentrates on the value of combining two or more imaging modalities with complementary information [41]. A recently initiated prospective multicenter study was designed to assess carotid plaque characteristics with several imaging modalities including ultrasound and MR imaging in order to identify patients with <70% carotid artery stenosis with an increased risk of recurrent stroke [42].…”

Section: Ceus Versus Mr Imagingmentioning

confidence: 99%

Molecular Imaging of Carotid Plaque Vulnerability

2014

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Background: Carotid endarterectomy (CEA) has been shown to be beneficial in patients with high-grade symptomatic carotid artery stenosis. Patients with high-grade asymptomatic stenosis may only exceptionally benefit from CEA during periods of increased plaque vulnerability. Imaging modalities to characterize unstable, vulnerable plaques are strongly needed for better risk stratification in these patients. Summary: Contrast-enhanced ultrasound (CEUS) is a novel and noninvasive technique capable to identify several surrogate markers of vulnerable carotid plaques. The use of specific ultrasound microbubbles allows a reliable detection of microulcerations due to an optimized visualization of the plaque-lumen border. As microbubbles are strictly intravascular tracers, the detection of individual microbubbles within the plaque corresponds to intraplaque neovessels. The accuracy of CEUS in the visualization of newly formed microvessels has been confirmed in histological studies on carotid endarterectomy specimens. Together with the formation of adventitial vasa vasorum, intraplaque neovascularization is a strong predictor for symptomatic disease. The phenomenon of late phase contrast enhancement is based on the adherence of microbubble-containing monocytes on inflamed endothelium. Recent studies suggest that late phase contrast enhancement may reflect endothelial inflammation or activation within carotid plaques. The development of conjugated microbubbles that bind to specific ligands such as thrombotic material or neovessels has led to the term ‘molecular imaging'. CEUS with microbubbles targeted to P-selectin and VCAM-1, key molecules in leukocyte trafficking, was used to detect an inflammatory plaque phenotype, whereas microbubbles coupled to the VEGF-receptor may allow for a detection of neovascularization. Even though imaging with targeted microbubbles is yet in an experimental stage, this technique can visualize active plaque reorganization with increased vulnerability leading to generation of arterio-arterial embolism. Key Messages: The use of contrast-enhanced ultrasound can be recommended to assess atherosclerotic carotid lesions at risk for rupture. Prospective clinical studies are needed to validate the use of CEUS in patients with high risks of recurrent large artery strokes. In particular, this applies to the detection of intraplaque neovascularization, a well-established marker in preclinical and observational studies, while the clinical significance of late phase contrast enhancement still needs to be determined.

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Validity of Dual MRI and <sup>18</sup>F-FDG PET Imaging in Predicting Vulnerable and Inflamed Carotid Plaque

Cited by 56 publications

References 39 publications

Moving Beyond Luminal Stenosis: Imaging Strategies for Stroke Prevention in Asymptomatic Carotid Stenosis

Moving Beyond Luminal Stenosis: Imaging Strategies for Stroke Prevention in Asymptomatic Carotid Stenosis

Multimodal Medical Image Fusion in Cardiovascular Applications

Molecular Imaging of Carotid Plaque Vulnerability

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