Contrast-Enhanced Ultrasound Imaging of Intraplaque Neovascularization in Carotid Arteries: Correlation With Histology and Plaque Echogenicity Stefano Coli, Marco Magnoni, Giuseppe Sangiorgi, ...Massimiliano M. Marrocco-Trischitta, Giulio Melisurgo, Alessandro Mauriello, Luigi Spagnoli, Roberto Chiesa, Domenico Cianflone, Attilio Maseri Plaque neovascularization is associated with vulnerable and symptomatic atherosclerosis; therefore, we have evaluated carotid contrast-enhanced ultrasound imaging as a clinical tool to study intraplaque neovascularization. Thirty-two patients with 52 plaques were studied. In 17 patients, the surgical specimen was available for histological determination of microvessel density. In the surgical subgroup, plaques with higher contrast-agent enhancement showed a greater microvessel density. In the whole series of 52 lesions, echolucent plaques showed a greater contrast-agent enhancement. Contrast-enhanced ultrasound imaging can be used to study carotid plaque neovascularization and may become a tool to identify vulnerable plaques and monitor response to therapy.
The reports describing that obesity per se predisposes to gastroesophageal reflux disease (GERD) have brought conflicting results. Establishing a causal link between these two conditions would be of ...major public health importance, because of their present epidemic proportions. To date, some large studies examining the relationship between obesity and GERD found a strongly positively relationship while others did not. The main cause of this discordance is the vast heterogeneity of such studies: sufficiently powerful design is found only in few investigations, GERD is defined with a low degree of homogeneity, biases are obvious in the choice of diagnostic methods, thus giving room for large variations in the adjustment of potential confounding factors. Future research should take three directions: 1) prospective population-based studies in which the incidence or recurrence of GERD should be evaluated in correlation with body mass index; 2) intervention trials, focusing on the benefit of weight loss in the prevention of GERD and its recurrence; 3) studies of physiopathology (both in the animal models and humans) to understand the potential biological plausibility.
Abstract The growing discoveries coming from clinical and basic research during the past decades have revolutionized our knowledge regarding pathophysiologic mechanisms underlying the atherosclerotic ...process and its thrombotic complications. The traditional view focusing on the severity of stenosis of atherosclerotic plaque has given way to the evidence that the clinical complications of atherosclerotic vascular disease, particularly the propensity to develop thrombotic complications, are determined mainly by the biological composition of the plaque. This paradigm shift has reinforced the need to move from the sole anatomical assessment toward combined anatomic and functional imaging modalities enabling the molecular and cellular characterization of the disease on top of its structural properties. Together, the progress to identify molecular targets related to plaque vulnerability and the improvement of imaging techniques for the detection of such molecular targets have allowed us to obtain new important pathophysiological information. This might allow better patient stratification for the identification of subjects at high risk to develop premature atherosclerosis who might need an aggressive therapeutic approach. Nuclear techniques, magnetic resonance imaging, computed tomography angiography, and contrast-enhanced ultrasound represent the currently available non-invasive imaging modalities for molecular imaging which can provide different and complementary insights into the biological features of the atherosclerotic process. This clinical review will discuss the evidence and potential translational applications of the individual imaging techniques particularly concerning their ability to detect the main atherosclerotic features related to plaque vulnerability, such as plaque inflammation and intertwined neovascularization.
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