Circ Cardiovasc Imaging

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Presentation transcript:

Circ Cardiovasc Imaging In vivo Detection of Vulnerable Atherosclerotic Plaque by MRI in a Rabbit ModelCLINICAL PERSPECTIVE by Alkystis Phinikaridou, Frederick L. Ruberg, Kevin J. Hallock, Ye Qiao, Ning Hua, Jason Viereck, and James A. Hamilton Circ Cardiovasc Imaging Volume 3(3):323-332 May 18, 2010 Copyright © American Heart Association, Inc. All rights reserved.

Figure 1. Experimental timeline. Figure 1. Experimental timeline. Rabbits were fed a 1% cholesterol diet for 2 weeks before and 6 weeks after balloon injury of the abdominal aorta, followed by 4 weeks of normal chow diet. In vivo MRI of the rabbit aorta is performed before (pretrigger) and after the second (post-trigger) pharmacological triggering. Plasma biomarkers were also monitored at baseline, after 8 weeks of cholesterol diet, and before triggering. Alkystis Phinikaridou et al. Circ Cardiovasc Imaging. 2010;3:323-332 Copyright © American Heart Association, Inc. All rights reserved.

Figure 2. In vivo T1BB images and histopathology of stable and vulnerable plaques before and after pharmacological triggering (magnified views are provided at the bottom right of each pane). Figure 2. In vivo T1BB images and histopathology of stable and vulnerable plaques before and after pharmacological triggering (magnified views are provided at the bottom right of each pane). The stable plaque appeared similar on the pretrigger (A) and (B) post-trigger images. C, Corresponding histology showed a thick fibrous cap over a lipid core. D, Vulnerable plaque that formed a luminal thrombus after triggering (E; asterisk). F, Corresponding Masson trichrome staining revealed the site of rupture (arrow) and confirmed the presence of a platelet and fibrin-rich thrombus. Alkystis Phinikaridou et al. Circ Cardiovasc Imaging. 2010;3:323-332 Copyright © American Heart Association, Inc. All rights reserved.

Figure 3. Examples of negative and positive remodeling in stable and vulnerable plaques. Figure 3. Examples of negative and positive remodeling in stable and vulnerable plaques. A, Types of vessel wall remodeling. The area circumscribed by the adventitial contour (blue line) indicates the vessel area. The remodeling ratio=vessel arealesion site/vessel areareference. The reference site is the site with the least amount of plaque. Positive remodeling and negative remodeling are defined from the remodeling ratio as shown. B to G, Examples of negative and positive remodeling in a stable (B to C) and a vulnerable (F to G) plaque compared with a reference site (D to E). B, D, and F, Flow-compensated images acquired with gadolinium showed negative remodeling at the site of a stable plaque (B) and positive remodeling at the site of a vulnerable plaque (H). C, E, and G, Flow-encoded images show the unobstructed luminal area. H, Frequency of negative, intermediate, and positive remodeling in stable and vulnerable plaques. Negative remodeling was significantly greater in stable plaques whereas positive remodeling was significantly greater in vulnerable plaques. Intermediate remodeling was similar between the 2 groups. RR indicates remodeling ratio; VA, vessel area; and LA, luminal area. Alkystis Phinikaridou et al. Circ Cardiovasc Imaging. 2010;3:323-332 Copyright © American Heart Association, Inc. All rights reserved.

Figure 4. Uptake of gadolinium in stable and vulnerable plaques. Figure 4. Uptake of gadolinium in stable and vulnerable plaques. Pretriggered T1BB MR images before (A, D, and G) and after (B, E, and H) injection of gadolinium-DTPA, with corresponding histological sections stained with Masson trichrome (C, F, and I). B, Stable plaque showed a mild enhancement (red arrow). C, Corresponding histology showed a thick fibrous cap overlaying a lipid core. E, Vulnerable plaque with circumferential enhancement. F, Histology verified that this was a vulnerable plaque that developed a thrombus after triggering. Red blood cell–filled neovessels (yellow arrow) spanned the fibrous cap underneath the thrombus. H, Vulnerable plaque with a crescent enhancement. I, Histology showed a luminal thrombus (asterisk) and a thin fibrous cap (arrowhead). Yellow circles indicate neovessels in the intima and adventitia. J, Frequency of the enhancement pattern after injection of gadolinium-DTPA in stable and vulnerable plaques. The frequency of the presence of circumferential and crescent-shaped enhancement pattern after injection of gadolinium was statistically higher in vulnerable compared with stable plaques. Alkystis Phinikaridou et al. Circ Cardiovasc Imaging. 2010;3:323-332 Copyright © American Heart Association, Inc. All rights reserved.