Comparison of Carotid Plaque Ulcer Detection Using Contrast-Enhanced and Time-of-Flight MRA Techniques

Introduction: Extensive neovascularization in atherosclerotic plaque has been shown to be associated with plaque progression and instability, leading to atherosclerotic cardiovascular events. Contrast-enhanced ultrasound (CEUS) of the carotid artery is a potential technique for imaging plaque neovascularization. Hypothesis: Assessment of intra-plaque neovascularization of the carotid artery using quantitative analysis of CEUS provides prognostic information in patients with coronary artery disease (CAD). Methods: This study included 206 patients with stable CAD and with carotid intima-media thickness (IMT) > 1.1 mm. They underwent a CEUS examination of the carotid artery and were followed-up prospectively for < 38 months or until a cardiac event (cardiac death, non-fatal myocardial infarction [MI], unstable angina pectoris [uAP] requiring unplanned coronary revascularization, or heart failure requiring hospitalization). The degree of contrast signals measured within the carotid plaque after the intravenous injection of contrast material was quantified by calculating the increase in mean gray scale level within the region of interest of the carotid plaque, expressed as plaque enhanced intensity. Results: During the follow-up period (3 - 38 months, mean 22.8 ± 11.8 months), 31 events occurred (2 cardiac deaths, 7 non-fatal MIs, 16 uAP, and 6 heart failure). Multivariate Cox proportional hazards analysis showed that plaque enhanced intensity was a significant predictor of cardiac events independent of traditional risk factors (HR, 1.52; 95% CI, 1.20 - 1.94; p = 0.001). The addition of plaque enhanced intensity had a significant incremental effect on the area under the ROC curve (AUC) generated using baseline model of traditional risk factors (AUC: baseline model 0.69 vs. baseline model + plaque enhanced intensity 0.78, p = 0.03). The addition of the plaque enhanced intensity to the baseline risk factors resulted in net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.58, p = 0.003; and IDI 0.078, p = 0.03). Conclusions: The assessment of carotid plaque neovascularization using quantitative analysis of CEUS may be useful for risk stratification in patients with CAD.

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Follow-up of intracranial aneurysms treated with stent-assisted coiling: Comparison of contrast-enhanced MRA, time-of-flight MRA, and digital subtraction angiography

Journal of Neuroradiology ◽

10.1016/j.neurad.2016.10.004 ◽

2017 ◽

Vol 44 (1) ◽

pp. 44-51 ◽

Cited By ~ 16

Author(s):

David Marciano ◽

Sébastien Soize ◽

Georgios Metaxas ◽

Christophe Portefaix ◽

Laurent Pierot

Keyword(s):

Digital Subtraction Angiography ◽

Intracranial Aneurysms ◽

Time Of Flight ◽

Digital Subtraction ◽

Contrast Enhanced

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Neonatal intracranial aneurysms: case report and review of the literature

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.10.peds17226 ◽

2018 ◽

Vol 21 (5) ◽

pp. 471-477 ◽

Cited By ~ 3

Author(s):

Jeewaka E. Mohotti ◽

Nicole S. Carter ◽

Victor Jia Wei Zhang ◽

Leon T. Lai ◽

Christopher Xenos ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Intracranial Aneurysms ◽

Time Of Flight ◽

Review Of The Literature ◽

Microsurgical Treatment ◽

Enhanced Mri ◽

Contrast Enhanced ◽

Mca Aneurysm ◽

Contrast Enhanced Mri

Intracranial aneurysms in the neonate, presenting in the first 4 weeks of life, are exceedingly rare. They appear to have characteristics, including presentation and location, that vary from those found in adults. The authors present a case of a 28-day-old neonate with a ruptured distal middle cerebral artery (MCA) aneurysm. Initial noninvasive imaging with transfontanelle ultrasound and CT confirmed intraparenchymal and subarachnoid hemorrhage. Contrast-enhanced MRI revealed a 14-mm ruptured fusiform MCA aneurysm that was not identified on time-of-flight magnetic resonance angiography (MRA). Microsurgical treatment was performed with partial neurological recovery. A comprehensive review of the literature from 1949 to 2017 revealed a total of 40 aneurysms in 37 neonates, including the present case. The most common presenting symptom was seizure. Although subarachnoid hemorrhage was the most common form of hemorrhage, 40% had intraparenchymal hemorrhage. The median aneurysm size was 10 mm (range 2–30 mm) and the most common location was the MCA, with two-thirds of cases involving the distal intracranial vasculature. Over the last 10 years, there has been a trend of increasing noninvasive diagnosis of ruptured cerebral aneurysms in neonates, with CT angiography and contrast-enhanced MRI being the most useful diagnostic modalities. The use of contrast-enhanced MRI may improve sensitivity over time-of-flight MRA. Microsurgical treatment was the most common treatment modality overall, with increased use of endovascular treatment in the last decade. Most patients underwent microsurgical vessel ligation or endovascular parent vessel occlusion. There were high rates of neurological recovery after microsurgical or endovascular treatment, particularly for patients with distal aneurysms.

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Superb microvascular imaging for detecting neovascularization of carotid plaque compared with contrast-enhanced ultrasound：A protocol for systematic review and meta analysis

10.37766/inplasy2020.7.0097 ◽

2020 ◽

Author(s):

Yang Zhou ◽

Cong Wang

Keyword(s):

Systematic Review ◽

Carotid Plaque ◽

Meta Analysis ◽

Contrast Enhanced ◽

Superb Microvascular Imaging ◽

Microvascular Imaging

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Ultrashort Echo Time Magnetic Resonance Angiography in Follow-up of Intracranial Aneurysms Treated With Endovascular Coiling: Comparison of Time-of-Flight, Pointwise Encoding Time Reduction With Radial Acquisition, and Contrast-Enhanced Magnetic Resonance Angiography

Neurosurgery ◽

10.1093/neuros/nyaa467 ◽

2020 ◽

Author(s):

Sung-Hye You ◽

Byungjun Kim ◽

Kyung-Sook Yang ◽

Bo Kyu Kim ◽

Jaeil Ryu

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Diagnostic Performance ◽

Time Of Flight ◽

Endovascular Coiling ◽

Residual Flow ◽

Radial Acquisition ◽

Contrast Enhanced ◽

Aneurysm Occlusion ◽

Time Reduction

Abstract BACKGROUND The optimal magnetic resonance angiography (MRA) sequence for assessing the aneurysm occlusion state or in-stent flow after endovascular coiling is not well established. OBJECTIVE To evaluate the diagnostic performance of pointwise encoding time reduction with radial acquisition (PETRA)-MRA in patients who underwent endovascular coiling relative to that of time-of-flight (TOF)-MRA and contrast-enhanced (CE)-MRA. METHODS We evaluated the aneurysm occlusion state using digital subtraction angiography (DSA) and MRA. In patients who underwent stent-assisted coiling, we estimated the visibility of in-stent flow. RESULTS We enrolled 189 patients with assessable TOF, PETRA, and CE-MRAs after coiling. In patients who underwent simple coiling (128 patients), PETRA showed a higher sensitivity in the detection of residual flow than TOF and CE (PETRA, 100%; CE, 83%; TOF, 80%). There were no significant differences in the height of residual flow between DSA (0.68 ± 1.45 mm) and PETRA (0.70 ± 1.50 mm; P = 1.000). In patients who underwent stent-assisted coiling (61 patients), PETRA showed the highest sensitivity (88%) in detecting residual flow (CE, 56%; TOF, 31%). Regarding in-stent flow, PETRA, CE, and TOF showed visual scores of ≥3 with frequencies of 96.7%, 85.2%, and 37.7%, respectively. Relative signal-to-noise ratio of PETRA (0.62 ± 0.18) was significantly higher than that of CE (0.56 ± 0.12) and TOF (0.39 ± 0.12; P < .001 for both). CONCLUSION PETRA-MRA showed excellent diagnostic performance in terms of residual flow detection and in-stent flow assessment. PETRA could be a versatile alternative sequence for following up patients with coiled aneurysm.

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