Developments in Magnetic Resonance Imaging of Atherosclerosis

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Citation
US Cardiology, 2007;4(1):63-5

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Atherosclerosis is a systemic disease that can silently affect the entire vascular system and often manifests clinically as stroke, myocardial infarction or sudden cardiac death. Despite advances in diagnosis and treatment, the sequelae of atherosclerosis remain the leading cause of death in adult Americans. Traditionally the gold standard for the diagnosis and assessment of atherosclerosis severity has been X-ray angiography which visualizes the reduction in arterial luminal diameter. However, it is now well-known that significant atherosclerotic plaque may be present within the arterial wall long before the lumen is compromised.1 In addition, plaque vulnerability, as determined by plaque composition, may be a better predictor of clinical risk than the severity of arterial stenosis.2 Angiographic modalities, which are blind to the vessel wall, cannot adequately delineate plaque composition and routinely underestimate atherosclerotic burden. Diagnostic techniques capable of imaging the arterial wall and characterizing atherosclerotic plaque provide a more accurate assessment of plaque burden, vulnerability, and possibly patient risk. Thus there is substantial interest in imaging modalities which can look beyond the arterial lumen into the vessel wall, such as high resolution magnetic resonance imaging (MRI).

Magnetic Resonance Imaging of Atherosclerosis

MRI has emerged as a leading non-invasive imaging modality of atherosclerotic disease due to its ability to assess the arterial lumen, plaque burden and plaque components in an accurate and non-invasive manner. MRI has been utilized in the research setting to evaluate atherosclerosis in human carotid, aortic, peripheral and coronary arteries. Several in vitro and in vivo studies have validated the ability of MRI to differentiate the major components of atherosclerotic plaque. In addition, MRI can accurately and reproducibly measure arterial wall dimensions. This has lead to its use as the imaging efficacy end-point in therapeutic trials of plaque regression.

Carotid Atherosclerosis

The carotid artery is an excellent target for MRI of atherosclerosis because of its superficial location, minimal motion, and available tissue pathology from carotid endarterectomy specimens. A substantial amount of work by Yuan and colleagues has validated the ability of MRI to detect and characterize carotid plaque.

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References
  1. Glagov S,Weisenberg E, Zarins CK, et al., Compensatory enlargement of human atherosclerotic coronary arteries, N Engl J Med, 1987;316:1371–5.
    Crossref | PubMed
  2. Virmani R, Kolodgie FD, Burke AP et al., Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions, Arterioscler Thromb Vasc Biol, 2000;20:1262–75.
    Crossref | PubMed
  3. Yuan C, Mitsumori LM, Ferguson MS, et al., In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques, Circulation, 2001;104 2051–6.
    Crossref | PubMed
  4. Cai J, Hatsukami TS, Ferguson MS, et al., In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque: comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology, Circulation, 2005;112:3437–44.
    Crossref | PubMed
  5. Hatsukami TS, Ross R, Polissar NL, et al., Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging, Circulation, 2000;102:959–64.
    Crossref | PubMed
  6. Yuan C, Zhang SX, Polissar NL, et al., Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke, Circulation, 2002;105:181–5.
    Crossref | PubMed
  7. Takaya N, Yuan C, Chu B, et al., Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI—initial results, Stroke, 2006;37:818–23.
    Crossref | PubMed
  8. Parmar J, Rodgers W, Kramer C, et al., Carotid Plaque MR Imaging During Possible TIA/Ischemic Stroke: A Comprehensive Analysis of Plaque Incidence, Outcomes and Cardiovascular Risk Factors, J Cardiovasc Magn Reson, 2007;9:151–2.
  9. Fayad ZA, Nahar T, Fallon JT, et al., In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography, Circulation, 2000;101:2503–9.
    Crossref | PubMed
  10. Chan SK, Jaffer FA, Botnar RM, et al., Scan reproducibility of magnetic resonance imaging assessment of aortic atherosclerosis burden, J Cardiovasc Magn Reson, 2001;3:331–8.
    Crossref | PubMed
  11. Kramer CM, Cerilli LA, Hagspiel K, et al., Magnetic resonance imaging identifies the fibrous cap in atherosclerotic abdominal aortic aneurysm, Circulation, 2004;109:1016–21.
    Crossref | PubMed
  12. Coulden RA, Moss H, Graves MJ, et al., High resolution magnetic resonance imaging of atherosclerosis and the response to balloon angioplasty, Heart, 2000;83:188–91.
    Crossref | PubMed
  13. Isbell DC, Meyer CH, Rogers WJ, et al., Reproducibility and reliability of atherosclerotic plaque volume measurements in peripheral arterial disease with magnetic resonance imaging, J Cardiovasc Magn Reson, 2007;1:71–6
    Crossref | PubMed
  14. Danias PG, Roussakis A, Ioannidis JP, Diagnostic performance of coronary magnetic resonance angiography as compared against conventional X-ray angiography: a meta-analysis, J Am Coll Cardiol, 2004;44:1867–76.
    Crossref | PubMed
  15. Kim WY, Stuber M, Bornert P et al., Three-dimensional black-blood cardiac magnetic resonance coronary vessel wall imaging detects positive arterial remodeling in patients with nonsignificant coronary artery disease, Circulation, 2002;106:296–9.
    Crossref | PubMed
  16. Desai MY, Lai S, Barmet C, et al., Reproducibility of 3D freebreathing magnetic resonance coronary vessel wall imaging, Eur Heart J, 2005;26:2320–24.
    Crossref | PubMed
  17. Maintz D, Ozgun M, Hoffmeier A, et al., Selective coronary artery plaque visualization and differentiation by contrast-enhanced inversion prepared MRI, Eur Heart J, 2006;27:1732–6.
    Crossref | PubMed
  18. Corti R, Fayad ZA, Fuster V, et al., Effects of lipid-lowering by simvastatin on human atherosclerotic lesions: a longitudinal study by high-resolution, noninvasive magnetic resonance imaging, Circulation, 2001;104:249–52.
    Crossref | PubMed
  19. Corti R, Fuster V, Fayad ZA, et al., Lipid lowering by simvastatin induces regression of human atherosclerotic lesions: two years’ follow-up by high-resolution noninvasive magnetic resonance imaging, Circulation, 2002;106:2884–7.
    Crossref | PubMed
  20. Sakuma H, Ichikawa Y, Chino S, et al., Detection of coronary artery stenosis with whole-heart coronary magnetic resonance angiography, J Am Coll Cardiol, 2006;48:1946–50.
    Crossref | PubMed
  21. Botnar RM, Stuber M, Lamerichs R, et al., Initial experiences with in vivo right coronary artery human MR vessel wall imaging at 3 tesla, J Cardiovasc Magn Reson, 2003;5:589–94.
    Crossref | PubMed
  22. Ruehm SG, Corot C, Vogt P, et al., Magnetic resonance imaging of atherosclerotic plaque with ultrasmall superparamagnetic particles of iron oxide in hyperlipidemic rabbits, Circulation, 2001;103: 415–22.
    Crossref | PubMed
  23. Nahrendorf M, Jaffer FA, Kelly KA, et al., Noninvasive vascular cell adhesion molecule-1 imaging identifies inflammatory activation of cells in atherosclerosis, Circulation, 2006;114:1504–11.
    Crossref | PubMed
  24. Trivedi RA, Mallawarachi C, King-Im JM, et al., Identifying inflamed carotid plaques using in vivo USPIO-enhanced MR imaging to label plaque macrophages, Arterioscler Thromb Vasc Biol, 2006;26:1601–6.
    Crossref | PubMed
  25. Sirol M, Itskovich VV, Mani V, et al., Lipid-rich atherosclerotic plaques detected by gadofluorine-enhanced in vivo magnetic resonance imaging, Circulation, 2004;109:2890–96.
    Crossref | PubMed
  26. Botnar RM, Perez AS, Witte S, et al., In vivo molecular imaging of acute and subacute thrombosis using a fibrin-binding magnetic resonance imaging contrast agent, Circulation, 2004;109:2023–9.
    Crossref | PubMed
  27. Rogers WJ, Prichard JW, Hu YL, et al., Characterization of signal properties in atherosclerotic plaque components by intravascular MRI, Arterioscler Thromb Vasc Biol, 2000;20:1824–30.
    Crossref | PubMed