Carotid Vessel Wall Imaging on CTA Baradaran, H; Gupta, A
American journal of neuroradiology : AJNR,
03/2020, Volume:
41, Issue:
3
Journal Article
Peer reviewed
Open access
Vessel wall imaging has been increasingly used to characterize plaque beyond luminal narrowing to identify patients who may be at the highest risk of cerebrovascular ischemia. Although detailed ...plaque information can be obtained from many imaging modalities, CTA is particularly appealing for carotid plaque imaging due to its relatively low cost, wide availability, operator independence, and ability to discern high-risk features. The present Review Article describes the current understanding of plaque characteristics on CTA by describing commonly encountered plaque features, including calcified and soft plaque, surface irregularities, neovascularization, and inflammation. The goal of this Review Article was to provide a more robust understanding of clinically relevant plaque features detectable on routine CTA of the carotid arteries.
CTA is a widely available imaging examination that may allow the evaluation of high-risk carotid plaque features.
Our aim was to evaluate the association between specific carotid plaque features on ...CTA and ipsilateral cerebrovascular ischemia.
We performed a systematic review of Ovid MEDLINE, Ovid Embase, Scopus, and the Cochrane Library from inception to March 2016 for articles that evaluated the relationship between CTA-detected carotid plaque features and ischemic events, defined as ipsilateral ischemic stroke or transient ischemic attack.
Sixteen studies were ultimately included after screening 12,557.
Two readers recorded data from each study and assessed the study quality with all disagreements resolved by a third reader. A random-effects OR was used to evaluate the association between cerebrovascular ischemia and each of the evaluated plaque features.
We found significant positive relationships with cerebrovascular ischemia for the presence of soft plaque (OR, 2.9; 95% CI, 1.4-6.0), plaque ulceration (OR, 2.2; 95% CI, 1.4-3.4), and increased common carotid artery wall thickness (OR, 6.2; 95% CI, 2.5-15.6). We found a significant negative relationship between calcified plaque and ipsilateral ischemia (OR, 0.5; 95% CI, 0.4-0.7).
We found heterogeneity in the existing literature secondary to lack of standardized plaque features and clinical definitions.
Soft plaque, plaque ulceration, and increased common carotid artery wall thickness on CTA are associated with ipsilateral cerebrovascular ischemia, while calcified plaque is negatively associated with downstream ischemic events.
Intracranial atherosclerosis is a common cause of ischemic stroke. Intracranial stenosis is most commonly quantified by the Warfarin-Aspirin Symptomatic Intracranial Disease method, which involves ...calculating a ratio of luminal diameter measurements on conventional angiography. Our purpose was to determine whether a single linear measurement of the narrowest caliber of the intracranial ICA on MRA can accurately predict Warfarin-Aspirin Symptomatic Intracranial Disease stenosis measurements.
We identified patients from a prospective stroke registry who had undergone head MRAs to quantitatively evaluate the degree of Warfarin-Aspirin Symptomatic Intracranial Disease-derived stenosis in each intracranial ICA. We also made a single linear millimeter measurement at the site of maximal narrowing of the ICA. We calculated a correlation coefficient between the lumen diameter in millimeters and percentage Warfarin-Aspirin Symptomatic Intracranial Disease stenosis. We performed receiver operating characteristic analysis to determine optimal luminal diameter cutoff values.
In 386 unique intracranial ICAs, we found a strong linear relationship between single lumen measurements and Warfarin-Aspirin Symptomatic Intracranial Disease-style stenosis measurements (
= -0.84,
< .0001). We found that ICA lumen diameters of ≤2.1 and ≤1.3 mm were optimal cutoffs for identifying patients with ≥50% stenosis and ≥70% stenosis, respectively (area under the curve = 0.96 and 0.99, respectively).
There is a strong linear relationship between the narrowest lumen diameter of the intracranial ICA and percentage stenosis. Our results suggest that a single lumen diameter measurement on MRA allows accurate estimation of Warfarin-Aspirin Symptomatic Intracranial Disease stenosis, which may affect risk stratification and treatment decisions.
Striae distensae (SD) or stretch marks are among the most common forms of atrophic scarring and cosmetic problems, especially in women, that negatively affect quality of life. The main causes of SD ...vary widely, but the most significant ones include obesity, pregnancy, high corticosteroid levels, weight changes, endocrine disorders and genetic predispositions. Various modalities are available for the treatment of SD; however, there is still no gold standard therapy for this condition. Given the many questions concerning the preferred therapeutic modalities for SD or their overall cost‐effectiveness, this comprehensive systematic review discusses the most prevalent, recent and promising therapies for SD in three main categories, including single therapy, therapeutic comparisons and combination therapy. A systematic search was carried out in Medline, Scopus, Web of Science and Google Scholar for original articles published on the treatment of SD by 20 May 2019. One hundred articles were reviewed and divided into three categories. In the single therapy category, we found that laser and other light‐based devices and topical treatments are the most commonly applied interventions. In the therapeutic comparison category, we found that most of the common therapeutic modalities are equally effective and there is no significant difference between them in side‐effects and treatment duration. In the combination therapy category, we found that the combination of two or more modalities is usually better than using each one alone.
The random laser has the potential to be replaced with the conventional cavity laser for abundant nanophotonics applications. For this purpose, it is essential to investigate the effect of using ...different materials as the diffusive medium in the random laser. We theoretically studied two groups of diffusive nanoparticles with some common materials used in the random lasers: metals (Au, Ag, Al) and dielectrics (TiO2, Si, GaAs). First, we compared the random lasing behavior with metal and dielectric triangle/sphere nanoparticles through the scattering cross section calculations. Then, the physical characteristics of triangle/sphere nanoparticles of both categories were investigated, resulting in the optimum scattering condition for the nanoparticles. Noteworthy, we have supposed that the triangle nanoparticles are made with colloidal lithography and randomly distributed in Rhodamine 6G as a gain medium for all simulations. We investigated that aluminum and titanium dioxide are good scatterers to interact with the gain medium over the photoluminescence emission spectrum. This study paves the way to design a more effective and applicable random laser for many potential applications.
Emerging evidence indicates that plaque imaging can improve stroke risk stratification in patients with carotid artery atherosclerosis. We studied the association between soft and hard (calcified) ...plaque thickness measurements on CTA and symptomatic disease status (ipsilateral stroke or TIA) in patients with moderate-grade carotid artery stenosis.
We measured soft-plaque and hard-plaque thickness on CTA axial source images in each carotid artery plaque in subjects with NASCET 50%-69% ICA stenosis. We used logistic regression and receiver operating characteristic analyses to assess the strength of the association between thickness measurements and prior stroke or TIA.
Twenty of 72 vessels studied (27.7%) had ischemic symptoms ipsilateral to the side of moderate-grade carotid stenosis. Each 1-mm increase in soft plaque resulted in a 3.7 times greater odds of a prior ipsilateral ischemic event (95% CI, 1.9-7.2). Conversely, for each 1-mm increase in hard plaque, the odds of being symptomatic decreased by approximately 80% (OR, 0.22; 95% CI, 0.10%-0.48%). Receiver operating characteristic analysis showed an area under the curve of 0.88 by using soft-plaque thickness measurements to discriminate between asymptomatic and symptomatic plaques. Sensitivity and specificity were optimized by using a maximum soft-plaque thickness of 2.2 mm, which provided a sensitivity of 85% and a specificity of 83%.
Simple CTA plaque-thickness measurements might differentiate symptomatic and asymptomatic moderate-grade carotid artery plaque. With further prospective validation, CTA plaque measures could function as an easily implementable tool for risk stratification in carotid artery disease.
Cognitive improvement has been reported after carotid revascularization and attributed to treating stenosis and correcting hypoperfusion. This study investigated the effect of carotid intraplaque ...hemorrhage on postintervention cognition.
In this institutional review board-approved single-center study, consecutive patients scheduled for carotid surgery were recruited for preoperative carotid MR imaging (MPRAGE) and pre- and postintervention cognitive testing using the Repeatable Battery for the Assessment of Neuropsychological Status. Pre- and postintervention scores were compared using
tests and multivariable linear regression.
Twenty-three participants were included, with endarterectomy performed in 20 (87%) and angioplasty/stent placement, in 3 (13%). Overall, statistically significant improvements occurred in the pre- versus postintervention mean Total Scale score (92.1 SD, 15.5 versus 96.1 SD, 15.8,
= .04), immediate memory index (89.4 SD, 18.2 versus 97.7 SD, 14.9,
< .001), and verbal index (96.1 SD, 14.1 versus 103.0 SD, 12.0,
= .002). Intraplaque hemorrhage (+) participants (
= 11) had no significant improvement in any category, and the attention index significantly decreased (99.4 SD, 18.0 versus 93.5 SD, 19.4,
= .045). Intraplaque hemorrhage (-) participants (
= 12) significantly improved in the Total Scale score (86.4 SD, 11.8 versus 95.5 SD, 12.4,
= .004), immediate memory index (82.3 SD, 14.6 versus 96.2 SD, 14.1,
= .002), delayed memory index (94.3 SD, 14.9 versus 102.4 SD, 8.0,
= .03), and verbal index (94.3 SD, 13.2 versus 101.5 SD, 107.4,
= .009). Postintervention minus preintervention scores for intraplaque hemorrhage (+) versus (-) groups showed statistically significant differences in the Total Scale score (-0.4 SD, 6.8 versus 8.0 SD, 8.5,
= .02), attention index (-5.9 SD, 8.5 versus 4.3 SD, 11.9,
= .03), and immediate memory index (4.2 SD, 6.7 versus 12.2 SD, 10.2,
= .04).
Cognitive improvement was observed after carotid intervention, and this was attributable to intraplaque hemorrhage (-) plaque. MR imaging detection of intraplaque hemorrhage status may be an important determinant of cognitive change after intervention.
We demonstrate a multilayer magnetoplasmonic structure fabricated from MoS
2
monolayer to significantly increase the magneto-optical Kerr effect (MOKE). The structure is made from glass/Au/Py/MoS
2
×
...n
(where
n
is the number of MoS
2
monolayers), and the MOKE enhancements are based on the surface plasmon resonance and the extraordinary light absorbing mechanism of the MoS
2
monolayers. The transverse MOKE (TMOKE) is about 18 times larger than that of Au/Py, suggesting the important role of the MoS
2
top layer. Moreover, the calculated
Q
-factor of the TMOKE signal is found to be about 623, indicating the presence of a sharp cavity resonance that dramatically influences the surface plasmon excitation. Our results convey a new pathway to the design of advanced magneto-optical devices for sensors, recording,
etc.
We demonstrate a multilayer magnetoplasmonic structure fabricated from MoS
2
monolayer to significantly increase the transverse magneto-optical Kerr effect (TMOKE) with a signal
Q
-factor more than 600.
Blood-brain barrier permeability is not routinely evaluated in the clinical setting. Global cerebral edema occurs after SAH and is associated with BBB disruption. Detection of global cerebral edema ...using current imaging techniques is challenging. Our purpose was to apply blood-brain barrier permeability imaging in patients with global cerebral edema by using extended CT perfusion.
Patients with SAH underwent CTP in the early phase after aneurysmal rupture (days 0-3) and were classified as having global cerebral edema or nonglobal cerebral edema using established noncontrast CT criteria. CTP data were postprocessed into blood-brain barrier permeability quantitative maps of PS (permeability surface-area product), K(trans) (volume transfer constant from blood plasma to extravascular extracellular space), Kep (washout rate constant of the contrast agent from extravascular extracellular space to intravascular space), VE (extravascular extracellular space volume per unit of tissue volume), VP (plasmatic volume per unit of tissue volume), and F (plasma flow) by using Olea Sphere software. Mean values were compared using t tests.
Twenty-two patients were included in the analysis. Kep (1.32 versus 1.52, P < .0001), K(trans) (0.15 versus 0.19, P < .0001), VP (0.51 versus 0.57, P = .0007), and F (1176 versus 1329, P = .0001) were decreased in global cerebral edema compared with nonglobal cerebral edema while VE (0.81 versus 0.39, P < .0001) was increased.
Extended CTP was used to evaluate blood-brain barrier permeability in patients with SAH with and without global cerebral edema. Kep is an important indicator of altered blood-brain barrier permeability in patients with decreased blood flow, as Kep is flow-independent. Further study of blood-brain barrier permeability is needed to improve diagnosis and monitoring of global cerebral edema.
Rosacea is a multifactorial skin inflammatory disorder with an unknown cure. Genetics and environmental factors such as microorganisms are involved in the rosacea etiology, for example,
have been ...suggested in rosacea progression. The present study investigated the relationship between
eradication and rosacea patient's improvement.
infection was investigated in 60 rosacea patients and 65 sex- and age-matched healthy control through enzyme-linked immunosorbent assay (ELISA) and HpSag tests. After infection confirmation, randomly half of the rosacea patients were treated for
eradication (test), and others received standard treatment (control). HpSag and ELISA tests were repeated after infection eradication and disease flow was surveyed for 60 days. The groups were compared using the ANOVA (Analysis Of Variance) test at the significant level of
< 0.05.
At the baseline, the mean of immunoglobulin G (IgG) (59.27 ± 41.4 RU/mL) and immunoglobulin M (IgM) (11.55 ± 6.1 RU/mL) in rosacea patients was higher than the level of IgG (41.38 ± 54.33 RU/mL) and IgM (8.11 ± 8.91 RU/mL) in healthy control (
< 0.04) and (
< 0.01), respectively. Also, the values for
infection were positive in all patients and 10 healthy controls. The mean titer of IgM and IgG in the test and control patients groups were different at baseline and after treatment. Furthermore, in the test patients group, the mean of IgG was reduced in active rosacea after treatment, and 63.9% of active patients showed rosacea remission after
eradication.
Data suggest the exacerbating role of
in rosacea, and its eradication along with other therapeutic methods causes rosacea improvement.
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