Association between antiplatelet medication and cerebral microbleeds in stroke-free population.

BACKGROUND: Cerebral microbleeds (CMBs) may increase the risk of future intracerebral hemorrhage and ischemic stroke. However, It is unclear whether antiplatelet medication is associated with CMBs. This study aimed to investigate the association between antiplatelet medication and CMBs in a community-based stroke-free population. METHODS: In this cross-sectional study, stroke-free participants aged 18-85 years were recruited from a community in Beijing, China. Demographic, clinical, and antiplatelet medication data were collected through a questionnaire, and all participants underwent blood tests and brain magnetic resonance imaging at 3.0T. The presence, count, and location of CMBs were evaluated using susceptibility-weighted imaging. The association between antiplatelet medication and the presence of CMBs was analyzed using multivariable logistic regression. The associations between antiplatelet medication and CMBs by location (lobar, deep brain or infratentorial, and mixed regions) were also analyzed using multinomial logistic regression. A linear regression analysis was conducted to determine the association between antiplatelet medication and the log-transformed number of CMBs. RESULTS: Of the 544 participants (mean age: 58.65 ± 13.66 years, 217 males), 119 participants (21.88%) had CMBs, and 64 participants (11.76%) used antiplatelet medication. Antiplatelet medication was found to be associated with CMBs at any location [odds ratio (OR) = 2.39, 95% CI: 1.24-4.58] and lobar region (OR = 2.83, 95% CI: 1.36-5.86), but not with the number of CMBs (ß = 0.14, 95% CI: -0.21-0.48). Among antiplatelet medications, aspirin use was found to be associated with any CMB (OR = 3.17, 95% CI: 1.49-6.72) and lobar CMBs (OR = 3.61, 95% CI: 1.57-8.26). CONCLUSIONS: Antiplatelet medication was associated with CMBs in stroke-free participants, particularly lobar CMBs. Among antiplatelet medications, aspirin use was associated with any CMB and lobar CMBs. Our findings suggest that it might be essential to optimize the management of antiplatelet medication in the stroke-free population with a higher burden of vascular risk factors to reduce the potential risk of CMBs.

A comparison of carotid atherosclerosis in symptomatic patients between 2002-2005 and 2012-2015 cohorts using multi-contrast magnetic resonance vessel wall imaging.

OBJECTIVE: To compare the morphological and compositional characteristics of carotid plaques in two cohorts (2002-2005 and 2012-2015) of Chinese patients using magnetic resonance vessel wall imaging. METHODS: Symptomatic patients with carotid atherosclerotic plaques who underwent carotid vessel wall magnetic resonance imaging between 2002-2005 and 2012-2015 were retrospectively recruited. Plaque morphology [including mean wall area, wall thickness, and maximum normalized wall index (NWI)] and composition [including calcification, intraplaque hemorrhage, and lipid-rich necrotic core (LRNC)] in symptomatic carotid arteries were evaluated and compared between patients in these two time periods. RESULTS: A total of 258 patients, including 129 patients in the 2002-2005 cohort and 129 patients in the 2012-2015 cohort, were recruited. Statin use (49.6%vs. 32.6%, P = 0.004) and hypertension (76.0% vs. 62.8%, P = 0.015) were significantly more common in the 2012-2015 cohort than in the 2002-2005 cohort. Patients in the 2012-2015 cohort also exhibited significantly low plaque burden parameters (allP < 0.05), as well as a lower prevalence (68.2% vs. 89.9%, P < 0.001) and volume percentages of LRNC (11.2% ± 14.2% vs. 25.7% ± 17.7%, P < 0.001). These differences remained significant after adjustment for clinical factors. The differences in the volume percentages of LRNC also remained significant after an additional adjustment for maximum NWI ( P < 0.001). CONCLUSIONS: Patients in the 2012-2015 cohort had a lower plaque burden and volume percentages of LRNC in symptomatic carotid arteries than those in the 2002-2005 cohort. These findings indicate that carotid plaques in the recent cohort had a lower severity and vulnerability.

Association of atherosclerotic plaque features with collateral circulation status in elderly patients with chronic carotid stenosis.

OBJECTIVE: To determine the association of carotid plaque features with collateral circulation status in elderly patients with moderate to severe carotid stenosis. METHODS: Elderly patients (> 60 years) with moderate to severe carotid stenosis were recruited and categorized into good and poor collateral circulation groups, and underwent magnetic resonance imaging and computed tomography imaging. The carotid plaque features including lipid-rich necrotic core, intraplaque hemorrhage, calcification, and fibrous cap rupture (FCR) were evaluated, and maximum wall thickness, normalized wall index (NWI), and luminal stenosis were measured. The association between these variables and collateral circulation status was analyzed. RESULTS: Of the 97 patients (78 males, mean age: 69.0 ± 6.1 years), 19 (19.6%) had poor collaterals. The poor collateral group had a significantly higher NWI (93.7% ± 5.0% vs. 89.0% ± 7.9%, P = 0.011), a greater extent of stenosis (80.0% ± 11.4% vs. 75.3% ± 9.4%, P = 0.036) and FCR (84.2% vs. 55.1%, P = 0.020) compared with good collateral group. Carotid NWI (OR = 3.83, 95% CI: 1.36-10.82, P = 0.011) and more FCR (OR = 6.77, 95% CI: 1.35-33.85, P = 0.020) were associated with poor collateral circulation after adjustment for the confounding factors. The combination of NWI, FCR, systolic blood pressure, and triglycerides had the highest area-under-the-curve (AUC = 0.85) for detection of poor collaterals. CONCLUSIONS: Carotid plaque features, specifically NWI and FCR, are independently associated with poor collateral circulation, and the combination of carotid plaque features and traditional risk factors has a stronger predictive value for poor collateral circulation than plaque features alone.

Irregular surface of carotid atherosclerotic plaque is associated with ischemic stroke: a magnetic resonance imaging study.

OBJECTIVE: To determine the association between the irregularity of carotid plaque surface using multidimensional magnetic resonance imaging (MRI) of ipsilateral acute cerebral infarction (ACI) cases. METHODS: Patients with recent cerebrovascular symptoms (stroke or transient ischemic attack < 2 weeks) and atherosclerotic plaque in at least one carotid artery were diagnosed by B-mode ultrasound imaging (intima-media thickness ≥ 1.5 mm) and recruited for the present study. Irregular surface was defined when plaque surface was uneven with high and low fluctuation or plaque with surface ulceration. The irregularity of carotid plaque surface was determined on axial or oblique images alone (single-dimension) and on both axial images and oblique images (multidimensions), separately. Univariate and multivariate logistic regression analyses were performed to calculate the odds ratio (OR) and the corresponding 95% CI of the irregular plaque surface in discriminating the presence of ipsilateral ACI. RESULTS: A total of 217 included subjects (mean age: 60.7 ± 10.2 years, 149 men) were recruited and 89 (41.0%), 88 (40.6%) and 118 (54.4%) of them exhibited irregular plaque surface on axial, oblique and multidimensional MR images, respectively. The OR of irregularity of the plaque surface was determined by multidimensional MRI to be 5.88 (95% CI: 3.16-10.96, P < 0.001) in discriminating the presence of ipsilateral ACI. Following adjustment for clinical confounding factors, this association remained statistically significant (OR = 5.65, 95% CI: 2.53-12.60, P < 0.001). The analysis included further adjustment for the presence of lipid-rich necrotic core, intraplaque hemorrhage and stenosis and the results included that this association also remained statistically significant (OR = 6.08, 95% CI: 2.52-14.68, P < 0.001). CONCLUSIONS: The irregular plaque surface was determined by multidimensional MRI as an independent indicator for ipsilateral acute cerebral infarction.

[Magnetic resonance imaging characteristics of unilateral versus bilateral intraplaque hemorrhage in patients with carotid atherosclerotic plaques].

OBJECTIVE: To investigate the difference in the vulnerability of carotid atherosclerotic plaques in patients with unilateral and bilateral intraplaque hemorrhage (IPH). METHODS: A retrospective analysis was conducted among 44 patients with unilateral IPH (30 cases) or bilateral IPH (14 cases) in the carotid plaques detected by magnetic resonance imaging (MRI) in our hospital between December, 2009 and December, 2012. The age, maximum wall thickness and incidence of fibrous cap rupture were compared between the two groups. RESULTS: Compared with those with unilateral IPH, the patients with bilateral IPHs had a significantly younger age (66.6∓9.4 years vs 73.7∓9.0 years, P=0.027), a significantly greater maximum plaque thickness (6.3∓1.9 mm vs 5.0∓1.3 mm, P=0.035) and a higher incidence of ulcers (50% vs 13.3%, P=0.025). Logistic regression analysis revealed a significant association between bilateral IPHs and the occurrence of ulcer with an odd ratio (OR) of 6.5 (95% confidence interval [CI]: 1.5-28.7, P=0.014). After adjustment for gender in Model 1, bilateral IPHs were still significantly associated with presence of ulcer (OR=5.7, 95%CI: 1.1-29.2, P=0.036). But after adjustment for age (P=0.131) or maximum plaque thickness (P=0.139) in model 2, no significant correlation was found between bilateral IPHs and the presence of ulcer. CONCLUSION: Compared with patients with unilateral IPH, those with bilateral IPHs are at a younger age and have a greater plaque burden and a higher incidence of fibrous cap rupture, suggesting a greater vulnerability of the carotid plaques in patients with bilateral IPHs.

Neovascularization in the carotid atherosclerotic plaque is not associated with inflammatory cell aggregation.

BACKGROUND: Monocytes and macrophages in atherosclerotic plaque lead to plaque instability. The aim of the study was to determine if plaque neovascularization led to inflammation. METHODS: Patients were consecutively enrolled if their carotid intimal media thickness was > 2 mm, as revealed by duplex ultrasound. The patients then underwent dynamic contrast enhanced magnetic resonance imaging (DCE MRI) and fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography combined with computed tomography (PET CT). A target to background ratio (TBR) of ≥ 1.25 or < 1.25 served as the cutoff point for the presence and absence of inflammation, respectively. RESULTS: Twenty-six patients underwent bilateral carotid DCE MRI and 24 patients also underwent PET CT. One hundred and fifty-five plaques were evaluated by both DCE MRI and PET CT. There was no significant difference in plaque morphology between the TBR ≥ 1.25 (n = 61) and TBR < 1.25 (n = 94) groups. No significant differences were found in plasma volume and transfer constant between the TBR ≥ 1.25 and TBR < 1.25 groups. CONCLUSION: Our study did not find a significant correlation between plaque neovascularization and the aggregation of inflammatory cells.

Evaluation of focal fatty infiltration of the liver using color Doppler and contrast-enhanced sonography.

PURPOSE: To investigate the vascular characteristics of focal fatty infiltration (FFI) in the liver using color Doppler sonography (CDUS) and contrast-enhanced sonography (CEUS). METHODS: We prospectively examined 25 areas of FFI of the liver in 20 patients via conventional gray-scale sonography, CDUS, and CEUS. Cadence contrast pulse sequencing and the contrast agent SonoVue were used for CEUS examination. CEUS criteria for diagnosis of FFI were isoenhancement or hypoenhancement in the arterial phase and homogeneous isoenhancement in the portal and late phases. RESULTS: CDUS revealed a draining vein in 4 of 9 (44%) lesions in the hepatic hilum, whereas CEUS revealed a draining vein in 8 (89%) lesions. A vein was associated with the 2 lesions located at the edge of segment II on both CDUS and CEUS. Blood flow was seen on both CDUS and CEUS in the 2 lesions adjacent to the falciform ligament. In one patient, CDUS and CEUS revealed the mid-hepatic vein coursing between 2 FFIs. In the arterial phase of CEUS, the lesions were hypoenhancing in 44% (11/25), iso-enhancing in 44% (11/25), and hyperenhancing in 12% (3/25). In the portal phase and in the late vascular phase, all 25 lesions (100%) were iso-enhancing. Sensitivity of combined sonography and CDUS in the diagnosis of FFI was 44%, and overall accuracy was 81%. The sensitivity of CEUS in the diagnosis of FFI was 88%, and its overall accuracy was 96%. CONCLUSION: FFI in the porta hepatis is correlated with aberrant venous drainage. FFI around the falciform ligament may be related to divergence of the portal vein or unusual blood supply. In the arterial phase of CEUS, FFI lesions were iso-enhancing as often as they were hypoenhancing.

[Diagnostic accuracy of noninvasive coronary artery angiography using 64 multi-slice computed tomography on coronary atherosclerosis].

OBJECTIVE: To evaluate the diagnostic accuracy of 64 multislice computed tomography (MSCT) coronary angiography on the coronary atherosclerosis. METHODS: Sixty one (52 male, 9 female, averaged 58 +/- 11 yrs ) patients underwent conventional coronary angiography and 64-MSCT angiography for suspected coronary artery disease within 5 to 20 days. Coronary artery image quality was scored from 1 to 4 (image quality score, 1: poor; 2: good -; 3: good +, and 4: excellent) on RCA, LM, LAD and LCX, respectively. The coronary artery stenosis were divided into two groups by over than 50% and less than 50% and diagnostic accuracy was analyzed. The coronary plaques were divided as calcified and noncalcified plaque according to its density. The stenosis result from calcified and noncalcified plaque were analyzed. RESULTS: Mean score of image quality on RCA, LM, LAD and LCX was 3.57 +/- 0.18 with heart beats 50 - 104 bpm (mean 70 +/- 11 bpm). Compared with CAG, the sensitivity and specificity of 64-MSCT in evaluating stenosis are 94.45% and 96.15%, the false positive and false negative value are 3.85% and 4.55%. The sensitivity and specificity were 85.71% in evaluating stenosis result from noncalcified plaque and they were 83.33% and 31.57% result from calcified plaque. CONCLUSION: 64-MSCT is an accurate and feasible method in evaluating coronary artery stenosis compared to conventional coronary angiography. However the specificity was poor in evaluating calcified plaque.

[Multi-slice computed tomography of myocardial bridge and mural coronary artery and clinical significance thereof].

OBJECTIVE: To investigate the diagnosis of myocardial bridge and mural coronary artery (MB-MCA) with multi-slice computed tomography (MSCT) and clinical significance thereof. METHODS: 900 patients suspected as with coronary artery disease (CHD) underwent 64-slice computed tomography performed by 3 radiologists independently. When consistency was obtained among the independent interpretations of the tomogram among them the diagnosis of MB-MCA could be confirmed. The length of MCA and thickness of MB were measured, and the situation of the nearby arteries were observed and recorded. Based on the above mentioned 3 items the reference scoring criteria were established. RESULTS: 180 sites of MB-NCA were found in 167 (18.56%) of the 900 patients, 112 males and 55 females, aged 54.46 (33 - 84). 167 of the 180 sites of MB-MCA were located on the LAD (92.7%). MCA could be covered by MB in a form of semi-circularity (63.89%, 115/180) or circularity (36.11%, 65/180) The length of MCA was 18.7 mm +/- 10.2 mm, and the thickness of MB was 1.7 mm +/- 1.2 mm. 70% of the arteries proximal and/or distal to the MB-MCA were tortuous. Length of MCA < 10 mm, half-surrounding of MB, and smoothness of the proximal and distant vessels were scored as 1; length of MCA of 10 approximately 20 mm, thickness of MB < 1 mm, and tortuousness of the unilateral proximal or distant vessel were scored as 2; and length of MCA > 20 mm, thickness of MB > 1 mm, and tortuousness of the bilateral proximal and distant vessels were scored as 3. Coronary atherosclerosis was found in 88 of the 167 patients (52.69%). No significant correlation was found between coronary atherosclerosis and MB-MCA grade (u = 1.234, P > 0.05). CONCLUSION: Sixty-four-slice CT can be used to confirm the presence of MB = MCA and the morphology of coronary artery with MB-MCA. Coronary atherosclerosis is not significantly correlated with MB-MCA grade.