Journal of APPLIED BIOMEDICINE
ISSN 1214-0287 (on-line)
ISSN 1214-021X (printed)

Volume 6 (2008), No 1, p 1-14




Plaque imaging: clinical implications and use of invasive methods

Stanislav Tuma, David Tesar, Josef Veselka, Jiri Neuwirth

Address: Stanislav Tuma, Institute of Radiology and Toxicology, Faculty of Health and Social Studies, MEDIPOINT, Matice Skolske 17, 370 01 Ceske Budejovice, Czech Republic
sttuma@volny.cz

Received 5th October 2007.
Revised 30th December 2007.
Published online 15th January 2008.

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SUMMARY
The composition of artherosclerotic plaque can be distingushed from the normal physical properties of tissues by the inflammatory mediators and the cells' remodelling arterial walls, and can therefore be demonstrated by imaging methods. Imaging of the vulnerable atherosclerotic plaque is now accepted as the main target in the diagnostics of imminent acute complications in atherosclerosis. Recent results of clinical trials (Ross's, CAPTIM, PRAGUE 2) suggest facilitated intervention - primary angioplasty together with pre-hospital fibrinolysis during transportation - as the urgent therapeutical method of choice. This life-saving emergency treatment is considered to be invasive because of the angiography and intravascular ultrasonography.
Angiography ranges from digital subtraction angiography to three-dimensional imaging, together for example with the rotational acquisition of angiographic pictures. X-ray densitometry of the atherosclerotic plaque tissues is also a promising method for differentiation. In contrast, intravascular ultrasonography, by the direct use of varying frequencies, allows the differentiation of tissues, and the demonstration of their relationship by virtual histology. The plaques liable to rupture (unstable vulnerable plaques) contain a large lipid core covered by a thin fibroplastic cap layer with a number of macrophages and mastocytes, and it seems that they, the plaques, can be identified by a so called new "gold-standard" modality. The usefulness of invasive methods is not only in distinguishing pathological processes or the location and size of the atherosclerotic plaque and its calcified parts, but in attracting attention to the extent of its vulnerability. The response to therapy of the arterial wall can also be demonstrated.

KEY WORDS
atherosclerotic plaque; FDG-PET/CT; intravascular ultrasound; virtual histology; dual-source mutidetector-row CT; three-dimensional rotational angiography


REFERENCES
Adams GJ, Simoni DM, Bordelon CB Jr., Vick GW III, Kimball KT Insull WI Jr., Morrisett JD: Bilateral symmetry of human carotid artery atherosclerosis. Stroke 33:2575-2580, 2002.

Alvarez-Linera J, Benito-Leon J, Escribano J, Campollo J, Gesto R: Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. Am J Neuroradiol 24:1012-1019, 2003.

Anderson GB, Ashfort R, Steine DE, Fernandy R, Findlay JM: CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke 312:2168-2174, 2000.

Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas J-L, Goto S, Liau C-S, Richard AJ, Rother J, Wilson PWF: International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 295:180-189, 2006.

Blasko P, Ostadal P, Maly M, Veselka J: IVUS - virtual histology in the interventional cardiology. Cor Vasa 48:217, 2006.

Bonnefoy E, Lapostolle F, Leizorovicz A, Steg G, Mc Fadden EP, Dubien PY, Cattan S, Boullenger E, Machecourt J, Lacroute JM, Cassagnes J, Dissait F, Touboul P: On behalf of the Comparison of Angioplasty and Prehospital Thrombolysis in acute Myocardial Infarction (CAPTIM) study group. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction. Lancet 360:890-892, 2002.

Bots ML, Svand GW, Riley WA, Grobbee DE: Carotid intima-media thisckness measurements in intervention studies. Design options, progression rates, and sample size consideration: a point of view. Stroke 34:2985-2994, 2003.

Brunenberg E, Pujol O, Ter-Haar-Romeny B, Radova P: Automatic IVUS segmentation of atherosclerotic plaque with stop & go snake. Computer Science (Lecture Notes in Artificial Intelligence and Bioinformatics), 4191 LNCS - II:9-16, 2006.

Cervinka P, De Feyter PJ, Costa M, Sabate M, Lingthart JMR, Stasek J: Intravascular ultrasound in cardiology. Vnitr. Lek., 46:437-438, 2006.

Colao A, Di Somma C, Filippella M, Rota F, Pivonello R, Orio F, Vitale G, Lombardi G: Insulin-like growth factor-1 defficiency determines increased intima-media thickness ata common carotid arteries in adult patiens with growth hormone deficienty. Clin Endocrinol (Oxf.), 61:360-366,2004.

Colao A., Spiezia S, Di Somma C, Pivonello R, Marzullo P, Rota F, Musella T, Auriemma RS, De Martino MC, Lombardi G: Circulating insulin-growth factor-1 levels are correlated with the atherosclerotic profile in healthy subjects independenty of age. J Endocrinol Invest 28:440-448, 2005.

Coombs BD, Rapp JH, Ursell PC, Reilly LM, Saloner D: Structure of plaque at carotid bifurcation. High resolution MRI with histological correlation. Stroke 32:2516-2521, 2001.

Crouse JR: Thematic review series: patient-orinted research. Imaging atherosclerosis: state-of-the-art. J Lipid Res 47:1677-1699, 2006.

Davies JR, Rudd JH, Weissberg PL, Narula J: Radionuclide imaging for the detection of inflammation in vulnerable plaques. J Am Col .Cardiol, 18 (Suppl.8):C57-68,2006.

De Weert TT, Ouhlous M, Meijering E, Zondervan PE, Hendriks JM, van Sambeek MRHM, Dippel DWJ, van der Lugt A: In vivo characterization and quantification of atherosclerotic carotid plaque components with multidetector computed tomography and histopathological correlation. Arterioscl Tromb BASF Biol 26:2366-2372, 2006.

Ebrahim S, Papacosta O, Whincup P, Wannamethee G, Walker M, Nicolaides AN, Dhanjil S, Griffin M, Belcaro G, Rumley A, Lowe GDO: Carotid plaque, intima thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British Regional Heart Study. Stroke 30:841-850, 1999.

Elgersma OEH, Buijs PC, Wust AFJ, van der Graaf Y, Eikelboom BC, Mali WPTM: Maximum internal carotid arterial stenosis: assessment with rotational angiography versus conventional intraarterial digital subtraction angiography. Radiology 213:777-783, 1999.

Ferrieres J, Elias A, Ruidavets JB, Cantet C, Bongard V, Fauvel J, Boccalon H: Carotid intima-media thickness and coronary heart disease risk factors in a low-risk population. J. Hypertens. 17:743-748, 1999.

Fiedler J, Pavlu L, Molinsky J: Predikuje nezvetsena hodnota sire komplexu intima-media spolecne karotidy absenci vyznamnych stenoz pri koronarografii u nemocnych indikovanych k operacnimu reseni chlopenni vady a s absenci stenokardii? XXXII. den mladych kardiologu, Sanofi-Aventis, Praha, Abstr.:44, 2006.

Fujii K, KobayashiY, Mintz GS, Takebayashi H, Dangas G, Moussa I, Mehran R, Lansky AJ, Kreps E, Collins M, Colombo A, Stone GW, Leon MB, Moses JW: Intravascular ultrasound assessment of ulcerated ruptured plaques. A comparison of culprit and nonculprit lesions of patiens with acute coronary syndromes and lesions in patiens without acute coronary syndromes. Circulation 108:2473-2478, 2003.

Golledge J, Greenhalgh RM, Davies AH: The symptomatic carotid plaque. Stroke 31:774-781, 2000.

Haberl R: New concepts in cardiac imaging. J Clin Basic Cardiol 4:240, 2001.

Haberl R, Steinbigler P.: New perspectives of non-invasive imaging with cardiac CT. J Clin Basic Cardiol 4:241-243, 2001.

Halliburton SS, Schoenhagen P, Nair A, Stillman A, Lieber M, Tuzcu EM, Vince DG, White RD: Contrast enhancement of coronary atherosclerotic plaque: A high-resolution, multidetector-row computed tomography study of pressure-perfused, human ex-vivo coronary arteries. Cor Art Dis 17:553-560, 2006.

Hayes E: Researchers confront strengths, limitations of 64-slice CTA. Imaging Europ 22:5-6, 2006.

Hermann HC: Triple therapy for acute myocardial infarction: combining fibrinolysis, platelet Iib-IIIa inhibition and percutaneous coronary intervention. Am J Cardiol 85, Suppl. C:10-16, 2000.

Hollander M, Hak AE, Koudstaal PJ, Bots ML, Grobbee DE, Hofman A, Witteman JCM, Breteler MMB: Comparison between measures of atherosclerosis and risk of stroke. The Rotterdam Study. Stroke 34:2367-2373, 2003.

Honda M, Kawahara I, Kitagawa N, Tsutsumi K, Morikawa M, Hayashi T, Nagata I: Asymptomatic carotid artery plaques: use of magnetic resonance imaging to characterize vulnerable plaques in 65 cases. Surg Neurol 67:35-39, 2007.

Huang H, Virmani R, Younis H, Burke AP, Kamm RD, Lee RT: The impact of calcification on the biomechanical stability of atherosclerotic plaques. Circulation 103:1051-1056, 2001.

Kocik M, Malek I, Janek B, Zelizko M, Pirk J: Vyskyt aterosklerotickeho postizeni vencitych tepen v populaci darcu srdce. Cor Vasa 45:299-303, 2006.

Kovarnik T, Horak J, Dostal O, Aschermann M: Rozdily v morfologii aterosklerotickych platu ve vencitych tepnach u nemocnych se stabilni a nestabilni anginou pectoris. Studie s intravaskularnim ultrazvukem a virtualni histologii. XXXII. den mladych kardiologu, Sanofi-Aventis, Praha, Abstr 29, 2006.

Link J, Grossmann J, Grabener M, Mueller Huelsbeck S, Steffens JC, Brinkmann G, Heller M: Spiral CT angiography and selective digital subtraction angiography of internal karotid artery stenosis. Am J Neuroradiol 17:89-94, 1996.

Missler U, Mayer T, Bruckmann H, Kamm KF: Erste Erfahrungen mit der Rotationsangiographie in der Neuroradiologie. Kontraste 6:2-7, 1994.

Naghavi M, Falk E, Hecht HS, Jamieson MJ, Kaul S, Berman D, Fayad Z, Budoff M, Rumberger J, Shah PK: From vulnerable plaque to vulnerable patient-Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol 98, 2A:2-15, 2006.

Nalamothu BK, Bates ER: Percutaneous coronary intervention versus fibrinolytic therapy: is timing (almost) everything? Am J Cardiol 92:924-826, 2003.

Nasu K, Tsuchikane E, Katoh O, Vince D, Virmani R, Surmely J, Murata A, Takeda Y, Ito T, Ehara M: Accuracy in vivo coronary plaque morphology assessment: a validation study of in vivo virtual histology compared with in vitro histopathology. J Am Coll Cardiol 47:2405-2412, 2006.

Okane K, Ibaraki M, Toyoshima H, Sugawara S, Takahashi K, Miura S, Shimosegawa E, Satomi J, Kitamura K, Satoh T: 18F-FDG accumulation in atherosclerosis: use of CT and MR co-registration of thoracic and carotid arteries. Eur J Nucl Med Mol Imaging 33:589-594, 2006.

Olivek TB, Lammie A, Wright AR, Wardlaw J, Patel SG, Peek R, Ruckley V, Collie DA: Atherosclerotic plaque at the carotid bifurcation: CT angiographic appearance with histopathologic correlation. Am J Neuroradiol 20:897-901, 1999.

Pfadenhauer K, Rull T: Ultrasonographic and FDG-PET imaging in active giant cell arthritis of the carotid arteries. Vasa 34:269-271, 2005.

Porsche C, Walker L, Mendelow D, Birchall D: Evaluation of cross-sectional luminal morphology in carotid atherosclerotic disease by use of spiral CT angiography. Stroke 32:2511-2515. 2001.

Puppini G, Furlan F, Cirota N, Veraldi G, Piubello Q, Montemezzi S, Gortenuti G: Caratterizzazione delle placche carotidee aterosclerotiche: Comparazione tra risonanza magnetica e istologia. Radiol Med 111:921-930, 2006.

Rieber J, Meissner O, Babaryka G, Reim S, Oswald M, Koenig A, Schiele TM, Shapiro M, Theisen K, Reiser MF, Klauss V, Hoffmann U: Diagnostic accuracy of optical coherence tomography and intravascular ultrasound for the detection and characterization of atherosclerotic plaque composition in ex-vivo coronary specimens: A comparison with histology. Cor Art Dis 17:425-430, 2006.

Rodriguez-Granillo GA, Mc Fadden EP, Valgimigli M, van Mieghem CA, Regar E, de Feyter PJ, Serruys PW: Coronary plaque composition of non-culprit lesions, assessed by in vivo intracoronary ultrasound radiofrequency data analysis, is related to clinical presentation. Am Heart J 151:1020-1024, 2006.

Rodriguez-Granillo GA, Garcia-Garcia HM, Mc Fadden EP, Valgimigli M, Aoki J, De Feyter P, Serruys PW: In vivo intravascular ultrasound-derived thin-cap fibroatheroma detection using ultrasound radiofrequency data analysis. J Am Coll Cardiol 46:2038-2042, 2005.

Ross AM, Dozne KS, Reiner JS, Greenhouse SW, Fink C, Frey A, Moreyra E, Traboulsi M, Racine N, Riba AL, Thompson MA, Rohrbeck S, Lundergan CF: A randomized trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction: the PACT trial. J Am Coll Cardiol 34:1954-1962, 1999.

Rosvall M, Janzon L, Berglund G, Engstrom G, Hedblad B: Incidence of stroke is related to carotid IMT even in the absence of plaque. Atherosclerosis 179:325-331, 2003.

Saam T, Cai J, Ma L, Cai Y-Q, Ferguson MS, Polissar NL, Hatsukami TS, Yuan C: Comparison of symptomatic and asymptomatic atherosclerotic carotid plaque features with in vivo MR imaging. Radiology 240:464-472, 2006.

Sailer J, Rand T, Berg A, Sulzbacher I, Pelaschek P, Holzenbein T, Lammer J: High-resolution 3 T MR microscopy imaging of arterial walls. CardioVasc Interv Radiol 29:771-777, 2006.

Savino G, Schoepf JU, Costello P, Sulzbacher I, Pelaschek P, Holzenbein T, Lammer J: 64-slice CT angiography reliably detects and excludes significat coronary Artury stenosis on a per-patient but not a per-vessel or per-segment basis. Europ Radiol 16, Suppl. 1:303, 2006.

Sawada T, Shite J, Shinke T, Watanabe S, Otake H, Matsumoto D, Tanino Y, Ogasawara D, Paredes OL, Yokoyama M: Relationship between high sensitive C-reactive protein and coronary plaque component in patiens with acute coronary syndrome: Virtual Histology study. J Cardiol 48:141-150, 2006.

Schlosser T, Mohrs OK, Magedanz A, Nowak B, Voigtlander T, Schmermund A, Barkhausen J: Non-invasive coronary angiography using 64-detector row computed tomography. Europ Radiol 16, Suppl. 1:303, 2006.

Spahi I, Nicholls SJ, Tuzcu EM: Intravascular ultrasound in the current percutaneous coronary intervention era. Cardiol Clin 24:163-173, 2006.

Surmely JF, Nasu K, Fujita H, Terashima M, Matsubara T, Tsuchikane E, Ehara M, Kinoshita Y, Zheng QX, Tanaka N, Katoh O, Suzuki T: Coronary plaque composition of culprit/target lesions according to the clinical presentation: a virtual histology intravascular ultrasound analysis. Eur Heart J 27:2939-2944, 2006.

Takayama K, Taoka T, Nakagawa H, Myouchin K, Wada T, Sakamoto M, Fukusumi A, Iwasaki S, Kurokawa S, Kichikawa K: Successful percutaneous transluminal angioplasty and stenting for symptomatic intracranial vertebral artery stenosis using intravascular ultrasound virtual histology. Rad Med 25:243-246,2007.

Tsimikas S, Witztum JL: Shifting the diagnosis and treatment of atherosclerosis to children and young adults. A new paradigm for the 21st century. J Am Coll Cardiol 40:2122-2124, 2002.

Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM, Young JB, Nissen SE: High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation 103:2705-2710, 2001.

Valgimigli M, Rodriguez Granillo GA, Garcia-Garcia HM, Malagutti P, Regar E, de Jaegere P, de Feyter P, Serruys PW: Distance from the ostium as an independent determinant of coronary plaque composition in vivo: an intravascular ultrasound study based radiofrequency data analysis in humans. Eur Heart J 27:655-663, 2006.

Valgimigli M, Rodriguez Granillo GA, Garcia-Garcia HM, Vaina S, de Jaegere P, de Feyter P, Serruys PW: Plaque composition in the left main stem mimics the distal but not the proximal tract of the left coronary artery: influence of clinical presentation, length of the left main trunc, lipid profile, and systemic levels of C-reactive protein. J Am Coll Cardiol 49:23-31, 2007.

Von Birgelen C, Hartmann M: Intravascular ultrasound assessment of coronary atherosclerosis and percutaneous interventions. Minerva Cardioangiol 52:391-406, 2004.

Von Birgelen C, Li W, Bom N, Serruys PW: Quantitative three-dimensional intravascular ultrasound. Semin. Interv Cardiol 2:25-32, 1997.

Warburton L, Gillard J: Functional imaging of carotid atheromatous plaques. J Neuroimaging 16:293-301, 2006.

Widimsky P, Budesinsky T, Vorac D, Groch L, elizko M, Aschermann M, Branny M, Stasek J, Formanek P: Long distance transport for primary angioplasty vs thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial - Prague-2. Eur Heart J 24:94-104, 2003.

Yuan C, Zhang S-X, Polissar NL, Echelard D, Hatsukami TS: Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation 105:181-185, 2002.
CITED

Lu YP Wei J Shao QH Tang YY, Huang YL, Zhang HL, Yang W, Jing Z. Assessment of atherosclerotic plaques in the rabbit abdominal aorta with interleukin-8 monoclonal antibody-targeted ultrasound microbubbles. Mol Biol Rep. 40: 3083-3092, 2013.

Ammer K. Thermology on the internet - an update. Thermol Intern. 19: 15-28, 2009.

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