Kathuria / Molinari / Suri Atherosclerosis Disease Management

1. Auflage 2010
ISBN: 978-1-4419-7222-4
Verlag: Springer-Verlag
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 946 Seiten

Atherosclerosis is a degenerative process affecting blood vessels, which determines narrowing of the lumen, plaque growth, and hardening of the walls. It is a risk factor for cardiovascular diseases. The focus of this book is on the management of the atherosclerotic disease. The coverage of this book spans from histological presentation of the various stages of atherosclerotic lesions to the earliest studies in atherosclerosis therapy, from advanced clinical diagnosis to monitoring, follow-up, and home-care of the atherosclerotic patient. The book shows well-established diagnostic techniques covering several medical imaging modalities such as Ultrasounds, IVUS, MRI, Computer Tomography, along with new trends in early and advanced atherosclerosis diagnosis (innovative drugs and tissue characterization procedures). Surgical standards will be presented along with innovative experimental trials for the treatment of the atherosclerotic patient. The book will also cover emerging techniques based on molecular imaging and vibro-acoustics.

Dr. Jasjit Suri has spent over 20 years in biomedical engineering/sciences/devices and his last 14 years has been dedicated in the field of medical imaging modalities and its fusion. He has published more than 300 technical papers in body imaging and devices, relating to modalities like MR, CT, X-ray, Ultrasound, PET, SPECT, Elastography and Molecular Imaging. Dr. Chirinjeev Kathuria holds a Bachelor of Science (B.Sc.) degree and specialized in U.S. Health Care Policy and Administration and a Doctor of Medicine (M.D.) from Brown University. He also holds a Master's in Business Administration (M.B.A.) from Stanford University. Dr. Filippo Molinari received the Italian Laurea and the Ph.D. in Electrical Engineering from the Politecnico di Torino, Torino, Italy, in 1997 and 2000, respectively. Since 2002, he has been an assistant professor on the faculty of the Department di Electronics, Politecnico di Torino, where he teaches biomedical signal processing, biomedical image processing, and instrumentation for medical imaging.

Autoren/Hrsg.

Kathuria, Chirinjeev

Molinari, Filippo

Suri, Jasjit

Inhaltsverzeichnis

1;Contents;6
2;Contributors;10
3;Part I Histology, Pathologies and Associated Risks;16
3.1;Chapter 1: Introduction to the Pathology of Carotid Atherosclerosis: Histologic Classification and Imaging Correlation;17
3.1.1;1.1 Introduction;17
3.1.2;1.2 Atherosclerosis: A Historical Perspective;18
3.1.3;1.3 Introduction to Carotid Artery Atherosclerosis;19
3.1.3.1;1.3.1 Pathologic Evaluation of the Carotid Endarterectomy Specimen;19
3.1.3.2;1.3.2 Localization of Plaque at the Carotid Bifurcation;20
3.1.4;1.4 Classification of Atherosclerotic Disease;21
3.1.4.1;1.4.1 The AHA Classification Scheme;21
3.1.4.2;1.4.2 Limitations of the AHA Classification;22
3.1.4.3;1.4.3 Pathologic Features of Atherosclerosis and Modifications to the AHA Classification;24
3.1.4.3.1;1.4.3.1 Early, Asymptomatic Lesions;24
3.1.4.3.1.1;Intimal Thickening and Intimal Xanthoma;24
3.1.4.3.1.2;Pathological Intimal Thickening;25
3.1.4.3.2;1.4.3.2 Advanced Symptomatic Lesions;25
3.1.4.3.2.1;Fibrous Cap Atheroma;25
3.1.4.3.2.2;Progression of Atherosclerosis Leading to Plaque Enlargement;25
3.1.4.3.2.2.1;Intraplaque Hemorrhage;25
3.1.4.3.2.2.2;Thin Cap Fibrous Atheroma (Vulnerable Plaque);26
3.1.4.3.2.3;Lesions with Thrombi;28
3.1.4.3.2.3.1;Plaque Rupture with Luminal Thrombus/Organizing Thrombus;28
3.1.4.3.2.3.2;Plaque Rupture with Ulceration;29
3.1.4.3.2.3.3;Plaque Erosion;29
3.1.4.3.2.3.4;Calcified Nodule;29
3.1.4.3.3;1.4.3.3 Stable Atherosclerotic Plaque;30
3.1.4.3.3.1;Healed Rupture/Erosion;30
3.1.4.3.3.2;Fibrocalcific Plaques;31
3.1.4.3.3.3;Chronic Total Occlusion;31
3.1.4.4;1.4.4 Carotid vs. Coronary Disease: Differences in Plaque Morphology;31
3.1.5;1.5 Risk Factors Contributing to Symptomatic Carotid Disease and Correlation with Plaque Morphology;32
3.1.6;1.6 Comparison of Carotid Plaque Histology from Symptomatic and Asymptomatic Patients;33
3.1.7;1.7 Imaging Modalities for Carotid Arteries and Histopathological Correlation;36
3.1.7.1;1.7.1 Digital Subtraction Angiography;36
3.1.7.2;1.7.2 Doppler Ultrasound;36
3.1.7.3;1.7.3 CT Angiography;37
3.1.7.4;1.7.4 Magnetic Resonance Imaging;37
3.1.7.5;1.7.5 Role of Inflammation in Imaging;39
3.1.8;1.8 Conclusions;41
3.1.9;References;41
3.2;Chapter 2: Cardiovascular Risk in Subjects with Carotid Pathologies;50
3.2.1;2.1 Carotid Disease is an Index of Diffuse Atherosclerosis, Including Coronary Heart Disease;51
3.2.2;2.2 Cardiovascular Risk and CHD in Patients with Specific Conditions;52
3.2.2.1;2.2.1 Asymptomatic CVD;52
3.2.2.2;2.2.2 Patients with TIA/Stroke;52
3.2.2.3;2.2.3 Candidates for Carotid Endarterectomy;54
3.2.3;2.3 Controversies About Need for CHD Testing in Patients with CVD and Measures to Be Taken in Case of Positive Testing;56
3.2.4;2.4 Intima–media Thickness of the Carotid Artery and Cardiac Risk;58
3.2.4.1;2.4.1 Correlation with Coronary Angiography;58
3.2.4.2;2.4.2 Correlation with Cardiac Events;58
3.2.5;2.5 Conclusions;60
3.2.6;References;60
3.3;Chapter 3: Neurological Evaluation and Management of Patients with Atherosclerotic Disease;65
3.3.1;3.1 Stroke as Social Problem;65
3.3.2;3.2 Stroke and Atherosclerosis Early Prevention and Management;66
3.3.3;3.3 Objectives and End Points;68
3.3.4;3.4 Experimental Setup;69
3.3.4.1;3.4.1 Patients Inclusion Criteria;69
3.3.4.2;3.4.2 Exclusion Criteria;70
3.3.4.3;3.4.3 Ethical Issues;70
3.3.4.4;3.4.4 Functional and Instrumental Clinical Examinations;71
3.3.4.4.1;3.4.4.1 Clinical Examination;71
3.3.4.4.2;3.4.4.2 Laboratory and Hematochemical Exams;71
3.3.4.4.3;3.4.4.3 Instrumental Examinations;71
3.3.5;3.5 Sample Instrumental Data;72
3.3.6;3.6 Results and Impact on the Management of the Patient with Neurological Symptoms;75
3.3.7;References;78
3.4;Chapter 4: Pathology of Atherosclerotic Disease;82
3.4.1;4.1 Epidemiology of Atherosclerosis;83
3.4.2;4.2 Risk Factors;83
3.4.3;4.3 Normal Anatomy of the Arterial Vascular Wall;84
3.4.4;4.4 Pathology;85
3.4.5;4.5 Elementary Atheromasic Injuries;85
3.4.6;4.6 Relationship between fibrous capsule and prognostic significance of the lesions;90
3.4.7;4.7 Complicated Atheromasic Injuries;91
3.4.7.1;4.7.1 Calcification;91
3.4.7.2;4.7.2 Ulcers and Plaque Rupture;92
3.4.8;4.8 Etiopathogenetic Theories;93
3.4.9;References;94
3.5;Chapter 5: Stress Analysis on Carotid Atherosclerotic Plaques by Fluid Structure Interaction;97
3.5.1;5.1 Background;98
3.5.1.1;5.1.1 Stress-Related Plaque Rupture Hypothesis;98
3.5.1.2;5.1.2 Stress Studies on Plaques;99
3.5.1.2.1;5.1.2.1 2D Versus 3D Structure-Only Stress Analysis;100
3.5.1.2.2;5.1.2.2 3D Structure Analysis Only Versus Fluid Structure Interaction Stress Analysis;101
3.5.2;5.2 Methodology;103
3.5.2.1;5.2.1 Carotid Plaque Reconstructions from In Vivo MRI;103
3.5.2.1.1;5.2.1.1 MR Imaging Acquisition;103
3.5.2.1.2;5.2.1.2 3D Carotid Bifurcation and Arterial Plaque Reconstruction;103
3.5.2.1.2.1;Plaque Components Segmentation;103
3.5.2.1.2.2;3D Geometry Reconstruction of Carotid Bifurcation;105
3.5.2.2;5.2.2 FSI Simulation and Boundary Conditions;107
3.5.3;5.3 Simulation Result on Different Applications;109
3.5.3.1;5.3.1 Stress Analyses with Multiple Patients;109
3.5.3.1.1;5.3.1.1 Fluid Domain Results;110
3.5.3.1.2;5.3.1.2 Wall Tensile Stress;110
3.5.3.1.3;5.3.1.3 Wall Tensile Stress in the Fibrous Cap;112
3.5.3.1.4;5.3.1.4 Impact of Plaque Morphology to the Stress Distributions;113
3.5.3.2;5.3.2 Stress Analysis with TIA Patients;116
3.5.3.3;5.3.3 Effects of Lipid Core Volume and Fibrous Cap Thickness on Stress Distribution;118
3.5.4;5.4 Modeling Procedure Uncertainties Analysis;120
3.5.4.1;5.4.1 Geometry Reconstruction Reproducibility;120
3.5.4.2;5.4.2 Variation of Material Model Definition;121
3.5.4.3;5.4.3 Axial Stretch;122
3.5.4.4;5.4.4 Residual Stress;122
3.5.5;5.5 Discussions and Conclusion;123
3.5.6;5.6 Conclusion;124
3.5.7;References;125
4;Part II Ultrasound Imaging;129
4.1;Chapter 6: Methods in Atherosclerotic Plaque Characterization Using Intravascular Ultrasound Images and Backscattered Signals;130
4.1.1;6.1 Introduction;130
4.1.2;6.2 IVUS Data Collection Specification;131
4.1.2.1;6.2.1 In Vivo Acquisition;131
4.1.2.2;6.2.2 In Vitro Setup and Specimen Preparation;132
4.1.2.2.1;6.2.2.1 Local Marking of ROIs;133
4.1.2.2.2;6.2.2.2 Systematic Marking of ROIs;136
4.1.3;6.3 New Intravascular Ultrasound Methods for Atherosclerotic Plaque Characterization;137
4.1.3.1;6.3.1 Spectral and RF-Based Approaches;137
4.1.3.1.1;6.3.1.1 IVUS-Virtual Histology;138
4.1.3.1.2;6.3.1.2 IVUS-Integrated Backscatter;138
4.1.3.1.3;6.3.1.3 IVUS Elastography;140
4.1.3.2;6.3.2 Texture-Based Approaches;143
4.1.3.2.1;6.3.2.1 IVUS-Prognosis Histology;143
4.1.3.2.2;6.3.2.2 IVUS-Error Correcting Output Codes;145
4.1.3.2.3;6.3.2.3 IVUS-Image-Based Histology (IVUS-IBH);147
4.1.4;6.4 Challenges Associated with Atherosclerotic Tissue Characterization Algorithms;149
4.1.4.1;6.4.1 Variability of Tissue Signatures;150
4.1.4.2;6.4.2 Consistency Among PH Images in Adjacent Frames;151
4.1.4.3;6.4.3 Effects of Change of Pressure;151
4.1.4.4;6.4.4 Effects of Flowing Blood;153
4.1.4.5;6.4.5 Interpretation of Histological Images, Labeling of IVUS Frames, and Sufficiency of Data Sets;154
4.1.4.6;6.4.6 Classification of Tissues Behind the Arc of Calcified Plaques;155
4.1.5;6.5 Summary and Conclusion;156
4.1.6;Biographies;160
4.1.7;References;156
4.2;Chapter 7: Despeckle Filtering of Ultrasound Images;162
4.2.1;7.1 Introduction;163
4.2.2;7.2 Despeckle Filtering;166
4.2.2.1;7.2.1 Local Statistics Filtering;167
4.2.2.1.1;7.2.1.1 First-Order Statistics Filtering (DsFlsmv, DsFwiener);167
4.2.2.1.2;7.2.1.2 Homogeneous Mask Area Filtering (DsFlsminsc);168
4.2.2.2;7.2.2 Median Filtering (DsFmedian);169
4.2.2.3;7.2.3 Maximum Homogeneity Over a Pixel Neighborhood Filtering (DsFhomog);169
4.2.2.4;7.2.4 Geometric Filtering (DsFgf4d);169
4.2.2.5;7.2.5 Homomorphic Filtering (DsFhomo);170
4.2.2.6;7.2.6 Diffusion Filtering;171
4.2.2.6.1;7.2.6.1 Anisotropic Diffusion Filtering (DsFad);171
4.2.2.6.2;7.2.6.2 Coherent Nonlinear Anisotropic Diffusion Filtering (DsFnldif);172
4.2.2.7;7.2.7 Wavelet Filtering (DsFwaveltc);173
4.2.3;7.3 Methodology;174
4.2.3.1;7.3.1 Material;174
4.2.3.2;7.3.2 Recording of Ultrasound Images;174
4.2.3.3;7.3.3 Despeckle Filtering;174
4.2.3.4;7.3.4 Texture Analysis;175
4.2.3.5;7.3.5 Distance Measures;175
4.2.3.6;7.3.6 Univariate Statistical Analysis;176
4.2.3.7;7.3.7 kNN Classifier;176
4.2.3.8;7.3.8 Image Quality Evaluation Metrics;176
4.2.3.9;7.3.9 Visual Evaluation by Experts;178
4.2.4;7.4 Results;179
4.2.4.1;7.4.1 Evaluation of Despeckle Filtering on a Symptomatic Ultrasound Image and a Cardiac Image;179
4.2.4.2;7.4.2 Texture Analysis: Distance Measures, Table 7.2;180
4.2.4.3;7.4.3 Texture Analysis: Univariate Statistical Analysis, Table 7.3;182
4.2.4.4;7.4.4 Texture Analysis: kNN Classifier, Table 7.4;182
4.2.4.5;7.4.5 Image Quality Evaluation Metrics, Table 7.5;187
4.2.4.6;7.4.6 Visual Evaluation by Experts, Table 7.6;187
4.2.4.7;7.4.7 Intima–Media Complex and Plaque Segmentation;190
4.2.5;7.5 Discussion;192
4.2.6;7.6 Summary and Future Directions;196
4.2.6.1;7.6.1 Summary;196
4.2.6.2;7.6.2 Future Directions;198
4.2.6.3;Biographies;203
4.2.7;7.8 Appendix: An Example of Running the Despeckle Filtering Toolbox;199
4.2.8;References;199
4.3;Chapter 8: Use of Ultrasound Contrast Agents in Plaque Characterization;204
4.3.1;8.1 Introduction;205
4.3.2;8.2 Basics of Plaque Characterization by Ultrasounds;207
4.3.3;8.3 Experimental Protocol and Patients Selection;208
4.3.4;8.4 Ultrasound Images Segmentation Strategy;210
4.3.5;8.5 Plaque Characterization in Contrast: Enhanced Ultrasound Images;212
4.3.6;8.6 ceUS Plaque Characterization and Histology;216
4.3.6.1;8.6.1 Plaque with Calcium Deposits;216
4.3.6.2;8.6.2 Soft Unstable Plaque;218
4.3.7;8.7 Discussions, Limitations, and Future Perspectives;220
4.3.8;Biographies;226
4.3.9;References;222
4.4;Chapter 9: An Integrated Approach to Computer-Based Automated Tracing and IMT Measurement for Carotid Artery Longitudinal Ultrasound Images;229
4.4.1;9.1 Introduction;230
4.4.2;9.2 CALEXia Architecture;233
4.4.2.1;9.2.1 Automatic Recognition of the Common Carotid Artery;233
4.4.2.1.1;9.2.1.1 Selection of Seed Points;233
4.4.2.1.2;9.2.1.2 Fitting of Line Segments and Its Tracing;235
4.4.2.1.3;9.2.1.3 Line Segments Recognition and Classification;240
4.4.2.2;9.2.2 IMT Measurement Strategy;242
4.4.3;9.3 Design of Performance Metric;244
4.4.3.1;9.3.1 Image Database;244
4.4.3.2;9.3.2 Polyline Distance Metric and Performance Metric;245
4.4.3.2.1;9.3.2.1 Polyline Distance Metric;245
4.4.3.2.2;9.3.2.2 Mean System Error;247
4.4.3.2.3;9.3.2.3 IMT Metric;247
4.4.4;9.4 Performance Evaluation and Benchmarking;248
4.4.4.1;9.4.1 Automated Tracings of the Carotid Artery;248
4.4.4.2;9.4.2 Carotid Wall Segmentation and IMT Measurement;250
4.4.5;9.5 CALEXia Merits, Problems, and Perspectives;252
4.4.6;9.6 Conclusions;256
4.4.7;Biographies;258
4.4.8;References;256
4.5;Chapter 10: Inter-Greedy Technique for Fusion of Different Segmentation Strategies Leading to High-Performance Carotid IMT Measurement in Ultrasound Images;260
4.5.1;10.1 Introduction;261
4.5.2;10.2 Architecture of CULEXsa;263
4.5.3;10.3 Architecture of CALEXia;265
4.5.4;10.4 Architecture Based on Morphological Approach of Watershed Transform;266
4.5.5;10.5 Inter-Greedy Approach for Fusion of Multiple Image Processing Boundaries;269
4.5.6;10.6 Performance Evaluation Metrics and Image Dataset;271
4.5.7;10.7 Segmentation Performance;272
4.5.7.1;10.7.1 Performance Evaluation of Segmentation Techniques for Lumen–Intima;274
4.5.7.2;10.7.2 Performance Evaluation of Segmentation Techniques for Media–Adventitia;275
4.5.7.3;10.7.3 Performance of Greedy with Respect to CALEXia, CULEXsa, and WS;277
4.5.8;10.8 Error per Vertex for Different Segmentation Techniques;280
4.5.9;10.9 Intima–Media Thickness Measurement Performance of CALEXia, CULEXsa, WS, and Inter-Greedy Algorithms;281
4.5.10;10.10 Conclusions;282
4.5.11;Biographies;285
4.5.12;References;283
4.6;Chapter 11: Techniques and Challenges in Intima–Media Thickness Measurement for Carotid Ultrasound Images: A Review;287
4.6.1;11.1 Introduction;288
4.6.1.1;11.1.1 Rationale and Applications;288
4.6.1.2;11.1.2 Clinical Importance of Vessel Wall Segmentation;289
4.6.1.3;11.1.3 Relationship of Computer Measurements and CVD;292
4.6.1.4;11.1.4 Monitoring of Carotid Wall Evolution;292
4.6.2;11.2 Challenges in Carotid Wall Segmentation;293
4.6.2.1;11.2.1 Biological Variability in Normal and Pathology;294
4.6.2.2;11.2.2 Instrumental Variability;295
4.6.2.3;11.2.3 Noise Sources;295
4.6.3;11.3 Computer Methods in Carotid Wall Segmentation;297
4.6.3.1;11.3.1 Edge Tracking and Gradient-Based Techniques;297
4.6.3.2;11.3.2 Dynamic Programming Techniques;301
4.6.3.3;11.3.3 Active Contours (Snakes)-Based Segmentation;302
4.6.3.4;11.3.4 Local Statistics and Snakes;305
4.6.3.5;11.3.5 Nakagami Modeling;308
4.6.3.6;11.3.6 Hough Transform;310
4.6.3.7;11.3.7 Integrated Approach;311
4.6.3.8;11.3.8 3-D Segmentation Methods;312
4.6.3.9;11.3.9 IVUS Techniques;313
4.6.4;11.4 A Discussion on Correlation with Human Tracings;315
4.6.4.1;11.4.1 Mean Absolute Distance;315
4.6.4.2;11.4.2 Hausdorff Distance;316
4.6.4.3;11.4.3 Polyline Distance Metric;317
4.6.4.4;11.4.4 Percent Statistic Test;318
4.6.4.5;11.4.5 Manual and Computer-Measured IMT;319
4.6.5;11.5 Discussion and Future Perspectives;320
4.6.6;11.6 Conclusions;321
4.6.7;Biographies;329
4.6.8;References;322
4.7;Chapter 12: 3D Carotid Ultrasound Imaging;331
4.7.1;12.1 Introduction;332
4.7.2;12.2 3D Carotid Ultrasound Scanning Technique;333
4.7.2.1;12.2.1 Mechanical Linear 3D Carotid Ultrasound Imaging;333
4.7.2.2;12.2.2 3D Carotid Ultrasound Image Reconstruction;336
4.7.2.3;12.2.3 Viewing of 3D Carotid Ultrasound Images;336
4.7.3;12.3 Quantification of Carotid Atherosclerosis;337
4.7.3.1;12.3.1 Total Plaque Volume;337
4.7.3.2;12.3.2 Vessel Wall Volume;337
4.7.4;12.4 3D Carotid US Studies;337
4.7.4.1;12.4.1 Monitoring Carotid Atherosclerosis Regression;337
4.7.4.1.1;12.4.1.1 TPA Measurements of Intensive Statin Treatment of Carotid Atherosclerosis;340
4.7.4.1.2;12.4.1.2 VWV Measurements of Intensive Statin Treatment of Carotid Atherosclerosis;341
4.7.4.1.3;12.4.1.3 Generation of 3D and 2D Carotid Maps;343
4.7.4.1.4;12.4.1.4 Mapping Spatial and Temporal Changes in Carotid Atherosclerosis from 3D Images;346
4.7.5;12.5 Discussion;349
4.7.6;References;350
5;Part III X-Rays, CT, and MR Clinical Imaging;357
5.1;Chapter 13: CT Imaging in the Carotid Artery;358
5.1.1;13.1 General Introduction;358
5.1.2;13.2 CT Principles;359
5.1.2.1;13.2.1 General Overview;359
5.1.2.2;13.2.2 Scanning Parameters;361
5.1.3;13.3 Basic Post-processing Techniques in CTA;362
5.1.3.1;13.3.1 CTA Issues;369
5.1.4;13.4 Carotid Artery Imaging;370
5.1.4.1;13.4.1 Imaging Diagnostic Flowchart;370
5.1.4.2;13.4.2 Imaging Techniques;371
5.1.4.3;13.4.3 Digital Subtraction Angiography;371
5.1.4.4;13.4.4 Ultrasound Echo Colour Doppler;372
5.1.4.5;13.4.5 Magnetic Resonance Angiography;374
5.1.4.6;13.4.6 Other Imaging Modalities;376
5.1.4.6.1;13.4.6.1 [18F]-Fluorodeoxyglucose Positron Emission Tomography;376
5.1.4.6.2;13.4.6.2 Single-Photon Emission Computed Tomography;377
5.1.4.6.3;13.4.6.3 Scintigraphy;378
5.1.5;13.5 Carotid Artery Pathology and Stroke Risk;378
5.1.6;13.6 From the Concept of Luminal Narrowing to the Carotid Vulnerable Plaque;382
5.1.7;13.7 Plaque Luminal Morphology;384
5.1.7.1;13.7.1 Smooth Surface;384
5.1.7.2;13.7.2 Plaque Irregularities;384
5.1.7.3;13.7.3 Plaque Ulcerations;384
5.1.8;13.8 Analysis of the Different Types of Plaque;388
5.1.9;13.9 Carotid Plaque Volume;392
5.1.10;13.10 Plaque Components;393
5.1.10.1;13.10.1 Fibrous Cap;393
5.1.10.2;13.10.2 Intra-plaque Haemorrhage;396
5.1.10.3;13.10.3 Plaque Thrombus;396
5.1.10.4;13.10.4 Plaque Calcification;397
5.1.11;13.11 Plaque Eccentricity and Remodelling;398
5.1.12;13.12 Carotid Plaque Enhancement;399
5.1.13;13.13 Other Imaging Concepts on Carotid;400
5.1.13.1;13.13.1 The Carotid Artery Wall Thickness;400
5.1.13.2;13.13.2 Automated Plaque Analysis;401
5.1.14;13.14 Conclusion;402
5.1.15;Biography;414
5.1.16;References;402
5.2;Chapter 14: Fast, Accurate Unsupervised Segmentation of 3D Magnetic Resonance Angiography;415
5.2.1;14.1 Introduction;415
5.2.2;14.2 Slice-Wise Segmentation with the LCDG Models;418
5.2.3;14.3 Experimental Results;420
5.2.3.1;14.3.1 Segmentation of Natural TOF- and PC-MRA Images;421
5.2.3.2;14.3.2 Validating the Segmentation Accuracy with Special Phantoms;425
5.2.4;14.4 Conclusion;427
5.2.5;Biographies;434
5.2.6;14.5 Appendix: EM-Based Precise LCDG-Approximation of a Probability Distribution;428
5.2.6.1;14.5.1 Sequential EM-Based Initialization;428
5.2.6.2;14.5.2 Modified EM Algorithm for Refining LCDGs;429
5.2.7;References;431
5.3;Chapter 15: Noninvasive Imaging for Risk Prediction in Carotid Atherosclerotic Disease;437
5.3.1;15.1 Introduction;437
5.3.2;15.2 Carotid Plaque;438
5.3.3;15.3 B-Mode Ultrasound;438
5.3.4;15.4 Intima–Media Thickness;439
5.3.5;15.5 Degree of Stenosis;441
5.3.6;15.6 Origin of Stroke;443
5.3.7;15.7 Morphology and Texture of Plaques;444
5.3.7.1;15.7.1 Histology;444
5.3.7.2;15.7.2 Stages of Atherosclerosis;444
5.3.7.3;15.7.3 “Stable Plaque”;446
5.3.8;15.8 High-Resolution Magnetic Resonance Imaging;447
5.3.8.1;15.8.1 Fibrous Cap Status and Lipid Core;448
5.3.8.2;15.8.2 Hemorrhage;451
5.3.8.3;15.8.3 Perspective;454
5.3.8.4;15.8.4 Limitations of MRI-Based Plaque Imaging;455
5.3.9;Biographies;458
5.3.10;References;455
5.4;Chapter 16: Noninvasive Targeting of Vulnerable Carotid Plaques for Therapeutic Interventions;461
5.4.1;16.1 Introduction;461
5.4.2;16.2 The Vulnerable Plaque;462
5.4.3;16.3 B-Mode Ultrasonography;464
5.4.3.1;16.3.1 Intima/Media Thickness;464
5.4.3.2;16.3.2 Plaque Echogenicity;465
5.4.3.3;16.3.3 Plaque Irregularity;466
5.4.3.4;16.3.4 Molecular Contrast-Enhanced Ultrasonography;466
5.4.4;16.4 Magnetic Resonance Imaging;467
5.4.4.1;16.4.1 Morphological Parameters;468
5.4.4.1.1;16.4.1.1 Fibrous Cap and Lipid Rich-Necrotic Core;468
5.4.4.1.2;16.4.1.2 Fibrous Cap Disruption and Platelet Aggregation;469
5.4.4.1.3;16.4.1.3 Severity of Stenosis;470
5.4.4.1.4;16.4.1.4 Intraplaque Hemorrhage;470
5.4.4.1.5;16.4.1.5 Expansive Remodeling;471
5.4.4.1.6;16.4.1.6 Superficial Calcified Nodules;472
5.4.4.2;16.4.2 Flow Modeling with Shear Stress Estimation;473
5.4.4.3;16.4.3 Active Inflammation;475
5.4.4.3.1;16.4.3.1 Dynamic Contrast-Enhanced MRI and Neovascularization;476
5.4.4.3.2;16.4.3.2 USPIO-Enhanced MRI and Macrophage Content;477
5.4.5;16.5 Positron Emission Tomography and Single Photon Emission Computed Tomography;479
5.4.5.1;16.5.1 Inflammation;480
5.4.6;16.6 The Vulnerable Plaque in Clinical Trials;481
5.4.7;16.7 Future Directions;485
5.4.8;16.8 Summary;487
5.4.9;Biographies;497
5.4.10;References;490
5.5;Chapter 17: Noninvasive Imaging of Carotid Atherosclerosis;500
5.5.1;17.1 Introduction;500
5.5.2;17.2 Ultrasonography;502
5.5.2.1;17.2.1 Conventional B-Mode US;502
5.5.2.2;17.2.2 Contrast-Enhanced US;505
5.5.3;17.3 Transcranial Doppler;505
5.5.4;17.4 Multidetector-Row Computed Tomography;507
5.5.5;17.5 Magnetic Resonance Imaging;508
5.5.5.1;17.5.1 Conventional MRI;509
5.5.5.2;17.5.2 Dynamic CE MRI;512
5.5.5.3;17.5.3 Ultrasmall Particles of Iron Oxide-Enhanced MRI;513
5.5.6;17.6 Nuclear Imaging Techniques;514
5.5.6.1;17.6.1 Fluorine-18-Fluorodeoxyglucose PET;515
5.5.6.2;17.6.2 Annexin A5 Scintigraphy;516
5.5.7;17.7 Summary and Future Research Directions;517
5.5.8;Biographies;525
5.5.9;References;519
6;Part IV Treatment and Monitoring ofAtherosclerosis;529
6.1;Chapter 18: Treatment of Carotid Stenosis: Carotid Endarterectomy and Carotid Angioplasty and Stenting;530
6.1.1;18.1 Introduction;530
6.1.1.1;18.1.1 Diagnostic Tests;531
6.1.1.1.1;18.1.1.1 Duplex Scan;531
6.1.1.1.2;18.1.1.2 Magnetic Resonance Imaging;533
6.1.1.1.3;18.1.1.3 Computed Tomography Angiography;534
6.1.1.1.4;18.1.1.4 Angiography;534
6.1.1.2;18.1.2 Symptomatic and Asymptomatic Carotid Stenosis;535
6.1.1.3;18.1.3 Anaesthesiological Technique;536
6.1.1.4;18.1.4 Surgical Technique;540
6.1.1.4.1;18.1.4.1 Standard CEA (Direct Suture or with Patch);541
6.1.1.4.2;18.1.4.2 Eversion Technique;543
6.1.2;18.2 Special Issues;544
6.1.2.1;18.2.1 Shunt;544
6.1.2.2;18.2.2 Quality Check;544
6.1.2.3;18.2.3 Urgent Surgery;545
6.1.2.4;18.2.4 CEA/CABG: Staged, Combined, Reversed Approach;547
6.1.3;18.3 The Results of Surgery;548
6.1.3.1;18.3.1 Personal Experience;549
6.1.4;18.4 Endovascular Technique;549
6.1.4.1;18.4.1 Carotid Stenting Technique;549
6.1.4.2;18.4.2 Vascular Access;550
6.1.4.3;18.4.3 Diagnostic Catheters;550
6.1.4.4;18.4.4 Common Carotid Artery Access;550
6.1.4.5;18.4.5 Protection Systems;551
6.1.4.6;18.4.6 Stent Implantation;553
6.1.4.7;18.4.7 Pharmaceutical Protocol;554
6.1.4.8;18.4.8 Interdisciplinary Collaboration;556
6.1.4.9;18.4.9 Clinical Results of Carotid Stenting;556
6.1.4.10;18.4.10 Perioperative Complications;556
6.1.5;18.5 Conclusions;557
6.1.6;Biographies;562
6.1.7;References;558
6.2;Chapter 19: Drug Therapy and Follow-Up;564
6.2.1;19.1 Introduction;564
6.2.2;19.2 Physiopathology of Atherosclerosis as Target of Drug Action;567
6.2.2.1;19.2.1 Atherogenesis and Atherothrombosis;567
6.2.2.2;19.2.2 Endothelial Dysfunction;569
6.2.2.3;19.2.3 Lipoprotein Cholesterol Retention in the Arterial Intima;571
6.2.2.4;19.2.4 Proinflammatory Oxidized LDL and the Role of Monocytes–Macrophages;574
6.2.2.5;19.2.5 Apoptosis, Plaque Rupture, and Thrombus Formation;575
6.2.3;19.3 Biomarkers and Surrogate Endpoints;576
6.2.3.1;19.3.1 Quantitative Coronary Angiography;578
6.2.3.2;19.3.2 Carotid B-Mode Ultrasound;579
6.2.3.3;19.3.3 Coronary Intravascular Ultrasound;579
6.2.3.4;19.3.4 Magnetic Resonance Imaging;580
6.2.4;19.4 Hypolipidemic Drugs;581
6.2.4.1;19.4.1 Statins;581
6.2.4.1.1;19.4.1.1 Secondary Prevention Studies;583
6.2.4.1.2;19.4.1.2 Primary Prevention Studies;585
6.2.4.1.3;19.4.1.3 Angiographic Trials;585
6.2.4.1.4;19.4.1.4 Ultrasound Trials: cIMT Biomarkers;586
6.2.4.1.5;19.4.1.5 Coronary Intravascular Ultrasound Studies;586
6.2.4.1.6;19.4.1.6 Magnetic Resonance Imaging Studies;590
6.2.4.1.7;19.4.1.7 Pleiotropic Effects of Statins;591
6.2.4.2;19.4.2 Fibrates;594
6.2.4.3;19.4.3 Nicotinic Acid;597
6.2.4.4;19.4.4 Bile Acid Sequestrants;600
6.2.4.5;19.4.5 Cholesterol Absorption Inhibitors;601
6.2.5;19.5 Antihypertensive Drugs;603
6.2.5.1;19.5.1 Hypertension and Atherogenesis;603
6.2.5.2;19.5.2 The Renin-Angiotensin System as a Target of Antiatherosclerotic Drugs;605
6.2.5.3;19.5.3 First-Line Antihypertensive Drugs;608
6.2.5.4;19.5.4 Health Outcomes Associated with First-Line Antihypertensive Agents;610
6.2.5.5;19.5.5 Role of Blood Pressure Lowering;611
6.2.5.6;19.5.6 Antihypertensive Treatment and Carotid Intima–Media Thickness;614
6.2.6;19.6 Conclusions;617
6.2.7;References;617
6.3;Chapter 20: Control of Inflammation with Complement Control Agents to Prevent Atherosclerosis;633
6.3.1;20.1 Atherosclerosis;633
6.3.1.1;20.1.1 Pathogenesis of Atherosclerosis;633
6.3.1.2;20.1.2 Stages of Lesion Development;635
6.3.1.3;20.1.3 Animal Models of Atherosclerosis;635
6.3.1.4;20.1.4 Initiation and Progression of Atherosclerotic Lesions;636
6.3.1.5;20.1.5 Myocardial Infarction;637
6.3.1.6;20.1.6 Atherosclerotic Risk Factors;638
6.3.1.7;20.1.7 Low-Density Lipoprotein and Lipid Transport;639
6.3.1.8;20.1.8 Inflammation in Atherosclerosis;641
6.3.2;20.2 The Complement System;642
6.3.2.1;20.2.1 The Complement Cascade;642
6.3.2.2;20.2.2 Complement Activation Pathways;643
6.3.2.2.1;20.2.2.1 The Classical Pathway;643
6.3.2.2.2;20.2.2.2 The Lectin Pathway;645
6.3.2.2.3;20.2.2.3 The Alternative Pathway;645
6.3.2.2.4;20.2.2.4 The Membrane Attack Complex;646
6.3.2.3;20.2.3 Complement Inhibitors;646
6.3.2.4;20.2.4 The Complement Inhibitor Vaccinia Virus Complement Control Protein;647
6.3.2.5;20.2.5 Complement and Inflammation;647
6.3.2.6;20.2.6 The Complement System and Myocardial Infarction;648
6.3.3;20.3 The Role of Complement in Atherogenesis;648
6.3.3.1;20.3.1 Historical Notes;648
6.3.3.2;20.3.2 Complement and Cardiovascular Disease: Initial Findings;649
6.3.3.3;20.3.3 The Effect of VCP on Diet-Induced Atherosclerosis in C57BL Mice;651
6.3.3.4;20.3.4 Complement in Atherogenesis: Mode of Action;654
6.3.3.5;20.3.5 The Effect of Complement Inhibitors on Reperfusion Injury;656
6.3.3.6;20.3.6 Conclusions;659
6.3.4;Biographies;673
6.3.5;References;659
7;Part V Molecular and Emerging Technologies;676
7.1;Chapter 21: Vibro-Acoustography of Arteries;677
7.1.1;21.1 Introduction;677
7.1.2;21.2 Principle of Vibro-Acoustography;678
7.1.3;21.3 Detection of Arterial Calcifications: Experimental Results;679
7.1.4;21.4 Other Applications of This Technique;686
7.1.5;21.5 Detection Sensitivity;686
7.1.6;21.6 Image Resolution;687
7.1.7;21.7 Quantitative Measurements;687
7.1.8;21.8 Exposure Safety;688
7.1.9;21.9 Limitations of Vibro-Acoustography;688
7.1.10;21.10 Clinical Potential;689
7.1.11;21.11 Summary;690
7.1.12;Biographies;694
7.1.13;References;690
7.2;Chapter 22: Metabonomics in Patients with Atherosclerotic Artery Disease;697
7.2.1;22.1 Atherosclerosis and Metabonomics;698
7.2.2;22.2 Database and Subject Population Description;699
7.2.2.1;22.2.1 Patient Population;699
7.2.2.2;22.2.2 Instrumental Data;700
7.2.2.3;22.2.3 Hematochemical Variables;701
7.2.3;22.3 Analysis Architecture: Combination of ANOVA and Metabonomic Techniques;701
7.2.3.1;22.3.1 Correlation Analysis;703
7.2.3.2;22.3.2 Multidimensional ANOVA;704
7.2.3.3;22.3.3 Principal Component Analysis;704
7.2.3.4;22.3.4 Partial Least Squares;705
7.2.3.5;22.3.5 Discriminant Analysis;705
7.2.4;22.4 Database Reduction;706
7.2.5;22.5 Analysis of the Patients in Function of the Surgical Treatment;708
7.2.6;22.6 Patients and Plaque Type;711
7.2.7;22.7 Discussions and Future Perspectives;711
7.2.8;Biographies;716
7.2.9;References;713
7.3;Chapter 23: Molecular Imaging of Atherosclerosis;720
7.3.1;23.1 Introduction;721
7.3.2;23.2 Molecular Markers;721
7.3.3;23.3 Potential Molecular Targets of Atherosclerosis for Molecular Imaging;724
7.3.3.1;23.3.1 Adhesion Molecules;725
7.3.3.2;23.3.2 Oxidized LDL and Foam Cells;726
7.3.3.3;23.3.3 Neovessel Formation;726
7.3.3.4;23.3.4 Proteolytic Enzymes;727
7.3.3.5;23.3.5 Apoptosis;728
7.3.3.6;23.3.6 Fibrin Deposition and Thrombus Formation;728
7.3.4;23.4 Homing Ligands;729
7.3.5;23.5 Contrast Agents;731
7.3.6;23.6 Imaging Modalities;733
7.3.7;23.7 Image Analysis;736
7.3.8;23.8 Conclusions;738
7.3.9;Biographies;744
7.3.10;References;739
7.4;Chapter 24: Biologic Nanoparticles and Vascular Disease;745
7.4.1;24.1 Introduction;745
7.4.2;24.2 Infection and Atherosclerosis;746
7.4.3;24.3 History of Biologic Nanoparticles;746
7.4.4;24.4 Biochemical Characterization of Biologic Nanoparticles;747
7.4.5;24.5 Are Biologic Nanoparticles Lifeforms?;749
7.4.6;24.6 Biologic Nanoparticles as a Transmissible Cause of Disease;750
7.4.7;24.7 Nanoparticles: Toward a Unifying Hypothesis;753
7.4.8;24.8 Conclusions;753
7.4.9;Biographies;758
7.4.10;References;754
7.5;Chapter 25: (Shear) Strain Imaging Used in Noninvasive Detection of Vulnerable Plaques in the Carotid Arterial Wall;760
7.5.1;25.1 Introduction;761
7.5.2;25.2 Ultrasound Strain Imaging;762
7.5.3;25.3 Intravascular Strain Imaging;764
7.5.4;25.4 Noninvasive Strain Imaging Techniques;766
7.5.4.1;25.4.1 Longitudinal Cross-Section;767
7.5.4.1.1;25.4.1.1 Doppler-Based Methods;767
7.5.4.1.2;25.4.1.2 Registration-Based Method;767
7.5.4.1.3;25.4.1.3 Cross-Correlation-Based Methods;768
7.5.4.2;25.4.2 Transverse Cross-Sections;770
7.5.4.2.1;25.4.2.1 A-Line Based Beam Steering;770
7.5.4.2.2;25.4.2.2 Image-Based Beam Steering and Compounding;770
7.5.5;25.5 Noninvasive Shear Strain Imaging Techniques;772
7.5.5.1;25.5.1 Echo-Tracking;772
7.5.5.2;25.5.2 Relative Lateral Shift;773
7.5.5.3;25.5.3 Radiofrequency-Based Ultrasound;773
7.5.6;25.6 Conclusions;775
7.5.7;Biographies;779
7.5.8;References;775
7.6;Chapter 26: Intravascular Photoacoustic and Ultrasound Imaging: From Tissue Characterization to Molecular Imaging to Image-Guided Therapy;781
7.6.1;26.1 Intravascular Ultrasound and Photoacoustic Imaging;782
7.6.1.1;26.1.1 Intravascular Ultrasound Imaging;782
7.6.1.2;26.1.2 Intravascular Photoacoustic Imaging;783
7.6.2;26.2 Arterial Tissue Characterization Using Spectroscopic IVPA Imaging;785
7.6.3;26.3 Molecular and Cellular-Specific IVPA Imaging;789
7.6.3.1;26.3.1 IVPA Imaging of Macrophages Labeled With Au NPs: Cell Study;790
7.6.3.2;26.3.2 Spectroscopic IVPA Imaging of Macrophages in an Animal Model of Atherosclerosis;793
7.6.4;26.4 IVPA Monitoring of Stent Deployment;795
7.6.5;26.5 Design of an Integrated Catheter for Combined Coronary IVUS/IVPA Imaging;799
7.6.6;Biographies;808
7.6.7;References;804
7.7;Chapter 27: Evaluation Criteria of Carotid Artery Atherosclerosis: Noninvasive Multimodal Imaging and Molecular Imaging;811
7.7.1;27.1 Introduction;812
7.7.1.1;27.1.1 Clinical Symptoms of Carotid Artery Disease;813
7.7.1.1.1;27.1.1.1 Presurgery Evaluation;813
7.7.1.1.2;27.1.1.2 Postsurgery Evaluation;814
7.7.2;27.2 Presurgery Evaluation;814
7.7.2.1;27.2.1 Presurgery Evaluation by Imaging of Carotid Artery Disease;817
7.7.2.1.1;27.2.1.1 Available In Vivo Imaging Techniques;817
7.7.2.1.2;27.2.1.2 Choice of Imaging Modalities in Presurgery Evaluation;820
7.7.2.2;27.2.2 Plaque Classification and Plaque Typing;820
7.7.2.2.1;27.2.2.1 Human Atherosclerotic Lesions and ACC/ACR Classification on Imaging;820
7.7.2.2.2;27.2.2.2 A Proposed Carotid Artery Stenosis Evaluation of Plaque Characterization;824
7.7.2.2.2.1;Criteria of Patient Selection;826
7.7.2.2.2.2;Statistical Methods Used in Diagnostic Accuracy in In Vivo MRI Images;826
7.7.2.3;27.2.3 Presurgery Assessment of Carotid Plaque Magnetic Resonance Imaging and Spectroscopy In Vivo: Where We Are Today?;827
7.7.2.3.1;27.2.3.1 Magnetic Resonance Macroimaging at 1.5 T In Vivo of Carotid Arteries by Multiple Contrast;828
7.7.2.3.2;27.2.3.2 MRI at 1.5 T of Carotid Arteries In Vivo: Multiple Contrast Technique and Quantitative Analysis;829
7.7.2.3.3;27.2.3.3 Multiple Contrast Technique;829
7.7.2.4;27.2.4 Quantitative MRI Analysis;830
7.7.2.4.1;27.2.4.1 Segmentation4;830
7.7.2.4.2;27.2.4.2 Selection of TE and TR for Optimizing Contrast Between Specific Atheroma Core vs. Fibrous Cap Plaque Components;830
7.7.2.4.3;27.2.4.3 Parametric Imaging for Segmentation and Quantitation of Lesion Components Based on Their T1 and T2 Values;831
7.7.2.4.4;27.2.4.4 Feature Space Analysis for Segmentation and Quantitation of Different Lesion Components Based on Combinations of Their T1, T2, and PD Values;832
7.7.2.4.5;27.2.4.5 Boundary Detection;832
7.7.2.5;27.2.5 Time Series of Changes in Different Sets of Images from Same Location;833
7.7.2.6;27.2.6 Presurgery Evaluation of Aggressive Statin Treatment on Carotid Atherosclerotic Lesions by Serial Ultrasound and MRI Measurements;834
7.7.3;27.3 Postsurgery CEA;835
7.7.3.1;27.3.1 Selection Criteria of Surgical Procedure;835
7.7.3.2;27.3.2 Evaluation Criteria of Endarterectomy Specimen;836
7.7.3.2.1;27.3.2.1 Results;837
7.7.3.3;27.3.3 Plaque Histopathology Classification;839
7.7.3.4;27.3.4 Endarterectomy Procedure;839
7.7.3.5;27.3.5 Carotid Artery Tissue Processing;840
7.7.3.6;27.3.6 Development of a Technique for Diagnostic Accuracy and Measurement of Plaque Composition: MRM at 1.5 Tesla Ex Vivo;841
7.7.3.7;27.3.7 Carotid Plaque Magnetic Resonance Spectroscopy at 9.4 T Ex Vivo: Molecular Nature of Plaque Type III–IV in Excised Tissues;841
7.7.3.8;27.3.8 Discriminative Analysis of Plaque Constituents;843
7.7.3.9;27.3.9 Associations Between Histopathology and MRI: Diagnostic Accuracy and Quantitation of Plaque Features;844
7.7.4;27.4 Ex Vivo Molecular Staining Techniques in Atherosclerosis;845
7.7.4.1;27.4.1 Matrix Metalloproteases;845
7.7.4.2;27.4.2 DNA Microarray;846
7.7.4.3;27.4.3 The Protein Microarray;846
7.7.5;27.5 Multimodal Molecular Imaging of Atherosclerosis Plaque Activity: An Emerging Art;846
7.7.5.1;27.5.1 Multimodal Imaging Principles;848
7.7.5.2;27.5.2 Available Multimodal Imaging Techniques;850
7.7.5.3;27.5.3 Molecular Imaging of Carotid Artery Plaques: How it Works?;852
7.7.5.4;27.5.4 Present State of Art in Carotid Artery Atherosclerosis and Angiogenesis Imaging;854
7.7.5.5;27.5.5 3D Molecular Imaging of Biomarkers by Nanoparticles;855
7.7.5.6;27.5.6 MALDI Imaging Technique;856
7.7.5.7;27.5.7 Microfluidics in Carotid Artery Disease;859
7.7.5.8;27.5.8 3D Echographic Data Segmentation to Evaluate Carotid Artery Turbulence;860
7.7.6;27.6 Limitations of Techniques in Evaluation of CAD;860
7.7.7;27.7 Future of Molecular Imaging of Carotid Artery Disease and Nanotechnology;862
7.7.8;27.8 Conclusion;862
7.7.9;Biographies;870
7.7.10;References;862
7.8;Chapter 28: Ultrasound and MRI-Based Technique for Quantifying Hemodynamics in Human Cardiovascular Systems;872
7.8.1;28.1 Introduction;872
7.8.2;28.2 Ultrasound Doppler;873
7.8.2.1;28.2.1 Conventional Ultrasound Doppler;874
7.8.2.1.1;28.2.1.1 Continuous Wave Doppler;874
7.8.2.1.2;28.2.1.2 Pulsed Wave Doppler;876
7.8.2.2;28.2.2 Color Flow Mapping;879
7.8.2.3;28.2.3 Vector Doppler;881
7.8.3;28.3 Speckle Tracking;885
7.8.4;28.4 Transverse Oscillation;889
7.8.5;28.5 Echo Particle Image Velocimetry;892
7.8.6;28.6 Phase-Contrast MRI;898
7.8.6.1;28.6.1 Methodology;898
7.8.6.2;28.6.2 Flow Imaging Capabilities;900
7.8.6.2.1;28.6.2.1 Global Flow Parameters;900
7.8.6.2.2;28.6.2.2 Local Flow Parameters;902
7.8.6.3;28.6.3 Clinical and Research Applications;902
7.8.6.3.1;28.6.3.1 Recent Developments;903
7.8.6.3.2;28.6.3.2 Imaging Local Flow in the Carotid;904
7.8.7;28.7 Summary;905
7.8.8;Biographies;911
7.8.9;References;905
8;Editor Biographies;913
9;Index;916