Advanced MRI for carotid plaque imaging.

Atherosclerosis is the ubiquitous underling pathological process that manifests in heart attack and stroke, cumulating in the death of one in three North American adults. High-resolution magnetic resonance imaging (MRI) is able to delineate atherosclerotic plaque components and total plaque burden within the carotid arteries. Using dedicated hardware, high resolution images can be obtained. Combining pre- and post-contrast T1, T2, proton-density, and magnetization-prepared rapid acquisition gradient echo weighted fat-saturation imaging, plaque components can be defined. Post-processing software allows for semi- and fully automated quantitative analysis. Imaging correlation with surgical specimens suggests that this technique accurately differentiates plaque features. Total plaque burden and specific plaque components such as a thin fibrous cap, large fatty or necrotic core and intraplaque hemorrhage are accepted markers of neuroischemic events. Given the systemic nature of atherosclerosis, emerging science suggests that the presence of carotid plaque is also an indicator of coronary artery plaque burden, although the preliminary data primarily involves patients with stable coronary disease. While the availability and cost-effectiveness of MRI will ultimately be important determinants of whether carotid MRI is adopted clinically in cardiovascular risk assessment, the high accuracy and reliability of this technique suggests that it has potential as an imaging biomarker of future risk.

Identification of Cardiac and Aortic Injuries in Trauma with Multi-detector Computed Tomography.

Blunt and penetrating cardiovascular (CV) injuries are associated with a high morbidity and mortality. Rapid detection of these injuries in trauma is critical for patient survival. The advent of multi-detector computed tomography (MDCT) has led to increased detection of CV injuries during rapid comprehensive scanning of stabilized major trauma patients. MDCT has the ability to acquire images with a higher temporal and spatial resolution, as well as the capability to create multiplanar reformats. This pictorial review illustrates several common and life-threatening traumatic CV injuries from a regional trauma center.

Carotid artery plaque morphology and composition in relation to incident cardiovascular events: the Multi-Ethnic Study of Atherosclerosis (MESA).

PURPOSE: To determine if carotid plaque morphology and composition with magnetic resonance (MR) imaging can be used to identify asymptomatic subjects at risk for cardiovascular events. MATERIALS AND METHODS: Institutional review boards at each site approved the study, and all sites were Health Insurance Portability and Accountability Act (HIPAA) compliant. A total of 946 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) were evaluated with MR imaging and ultrasonography (US). MR imaging was used to define carotid plaque composition and remodeling index (wall area divided by the sum of wall area and lumen area), while US was used to assess carotid wall thickness. Incident cardiovascular events, including myocardial infarction, resuscitated cardiac arrest, angina, stroke, and death, were ascertained for an average of 5.5 years. Multivariable Cox proportional hazards models, C statistics, and net reclassification improvement (NRI) for event prediction were determined. RESULTS: Cardiovascular events occurred in 59 (6%) of participants. Carotid IMT as well as MR imaging remodeling index, lipid core, and calcium in the internal carotid artery were significant predictors of events in univariate analysis (P < .001 for all). For traditional risk factors, the C statistic for event prediction was 0.696. For MR imaging remodeling index and lipid core, the C statistic was 0.734 and the NRI was 7.4% and 15.8% for participants with and those without cardiovascular events, respectively (P = .02). The NRI for US IMT in addition to traditional risk factors was not significant. CONCLUSION: The identification of vulnerable plaque characteristics with MR imaging aids in cardiovascular disease prediction and improves the reclassification of baseline cardiovascular risk.

The value of carotid artery plaque and intima-media thickness for incident cardiovascular disease: the multi-ethnic study of atherosclerosis.

BACKGROUND: Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease (CVD) and coronary heart disease (CHD) events. METHODS AND RESULTS: We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6% women) of the Multi-Ethnic Study of Atherosclerosis (MESA). ICA lesions were defined subjectively as >0% or ≥25% diameter narrowing, as continuous intima-media thickness (IMT) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5-mm IMT cut point. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CHD, and stroke. Harrell's C-statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8-year mean follow-up, all plaque metrics significantly predicted CVD events (n=515) when added to Framingham risk factors. All except 1 metric improved the prediction of CHD (by C-statistic, Net Reclassification Improvement, and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0%; P=0.0003) with risk ratio of 1.43/mm; 95% CI 1.26-1.63) followed by maximum IMT with an NRI of 6.8% and risk ratio of 1.27 (95% CI 1.18-1.38). CONCLUSION: Ultrasound-derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to Framingham risk factors.

Carotid artery plaque and progression of coronary artery calcium: the multi-ethnic study of atherosclerosis.

BACKGROUND: Carotid and coronary atherosclerosis are associated with each other in imaging and autopsy studies. The aim of this study was to evaluate whether carotid artery plaque seen on carotid ultrasound can predict incident coronary artery calcification (CAC). METHODS: Agatston calcium score measurements were repeated in 5,445 participants of the Multi-Ethnic Study of Atherosclerosis (MESA; mean age, 57.9 years; 62.9% women). Internal carotid artery lesions were graded as 0%, 1% to 24%, or >25% diameter narrowing, and intima-media thickness (IMT) was measured. Plaque was present for any stenosis >0%. CAC progression was evaluated with multivariate relative risk regression for CAC scores of 0 at baseline and with multivariate linear regression for CAC score > 0, adjusting for cardiovascular risk factors, body mass index, ethnicity, and common carotid IMT. RESULTS: CAC was positive at baseline in 2,708 of 5,445 participants (49.7%) and became positive in 458 of 2,837 (16.1%) at a mean interval of 2.4 years between repeat examinations. Plaque and internal carotid artery IMT were both strongly associated with the presence of CAC. After statistical adjustment, the presence of carotid artery plaque significantly predicted incident CAC with a relative risk of 1.37 (95% confidence interval, 1.12-1.67). Incident CAC was associated with internal carotid artery IMT, with a relative risk of 1.13 (95% confidence interval, 1.03-1.25) for each 1-mm increase. Progression of CAC was also significantly associated (P < .001) with plaque and internal carotid artery IMT. CONCLUSIONS: In individuals free of cardiovascular disease, subjective and quantitative measures of carotid artery plaques by ultrasound imaging are associated with CAC incidence and progression.

Detecting lesions in multiple sclerosis at 4.7 tesla using phase susceptibility-weighting and T2-weighting.

PURPOSE: To demonstrate 4.7 Tesla (T) imaging methods for visualizing lesions in multiple sclerosis in the human brain using phase susceptibility-weighting and T2 weighting. MATERIALS AND METHODS: Seven patients with relapsing-remitting multiple sclerosis were imaged at 4.7T using three-dimensional (3D) susceptibility-weighted imaging (SWI) with 0.90 mm(3) voxel volumes, and with 2D T2-weighted fast spin echo (T2WFSE) with 0.34 mm(3) voxels and 1.84 mm(3) voxels. The visibility of MS lesions at 4.7T with phase SWI and T2WFSE was assessed by independent lesion counts made by an experienced neuroradiologist, and by quantitative measures. RESULTS: High resolution T2WFSE at 4.7T provided excellent depiction of hyperintense lesions. When combined with phase SWI, 124 total lesions were identified of which 18% were only visible on phase SWI and not on T2WFSE. The phase lesions had a mean phase shift relative to local background of -11.15 +/- 5.97 parts per billion. CONCLUSION: Imaging at 4.7T can provide both high quality, high resolution T2WFSE and SWI for visualization of lesions in multiple sclerosis. Phase susceptibility-weighting can identify additional lesions that are not visible with high resolution T2WFSE.

Performance of steady-state free precession for imaging carotid artery disease.

PURPOSE: To evaluate steady-state free precession (SSFP) for diagnosing carotid artery disease. MATERIALS AND METHODS: Following bilateral x-ray angiography, seven patients with suspected carotid artery disease were imaged with SSFP, black blood fast spin echo (BB FSE), and time-of-flight MR angiography (TOF MRA). The techniques were compared for characterizing the vessel lumen. Flow phantom experiments were also performed, using speeds of 0 to 40 cm/second, to further evaluate the merits of each MR technique. RESULTS: In the patient studies, of the 14 arteries available, a correct grading of stenosis was possible with SSFP in 9 of 14, FSE in 12 of 14, and TOF in 13 of 14, assuming x-ray angiography as the gold standard. The SSFP technique was the least reliable and had severe artifacts in 5 of 14 arteries, making these images nondiagnostic. The flow phantom demonstrated that although the SSFP technique performs well under slow or no flow, it breaks down at higher flow levels. CONCLUSION: The continuous SSFP sequence used here was not reliable for imaging carotid artery disease owing to artifact in many cases. Nevertheless, the high speed of this SSFP technique does allow it to serve as a rapid scouting method prior to a more detailed evaluation with other MRI methods.