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Most clinical cardiac events due to

atherosclerosis occur suddenly (e.g.


AMI, UAP).
Typically caused by a disrupted or
ruptured atherosclerotic plaque with
overlying thrombus.
Neither fluoro x-ray nor IVUS can
identify the features of coronary
plaques that are vulnerable to rupture
from more stable plaques.
Evolution of therapeutic modalities
has increased the need to identify
vulnerable plaque.
DF Kacher

, E Larose , M Aikawa ,
E Rabkin *, S Kinlay , P Ganz , AP Selwyn ,
P Libby , EK Yucel



Brigham and Womens Hospital
Dept. of Radiology * Dept. of Pathology
Div. Cardiovascular Medicine, Dept. of Medicine
Pitfalls of Plaque
Identification
Chemical Shift



Vessel wall motion
Coil susceptibility
Partial Voluming
In-vivo IV MR Imaging of
Human Atherosclerosis
REFERENCES
Black et al.,.Neurosurgery,
41:831-842, 1997 (1998).
Ferrant M. et.al.,. IEEE
Transactions on Medical
Imaging, 20:1384-1397
(2001).
A. Balakrishnan et al. Proc.
ASME (2003).
Miller, K. et al.,. J Biomech,
33:1369-1376 (2000).
ACKNOWLEDGEMENTS:
NAC grant RR013218-06.
Correlation Between IV MRI and Histology
Force
MRI offers contrast of structures
within the vessel.
SNR of MRI surface coils and volume
coils is limited for deep vessels.
IV MRI coils are better volume
matched to the sample and can thus
achieve higher SNR.
Loopless coil is a flexible, scalable
design that can eventually fit into the
coronary arteries, unlike other IV coil
designs that offer higher SNR.
Proximal Shaft
Overall length (100 cm)
Imaging coil and
distal spring (9cm)
Silicon coating
Matching and isolation
circuit attachment site
a
IV Coil
Loopless antenna (Surgi-Vision)
Outer diameter 0.032
FDA approved
1.5T CV/i scanner (GEMS)
1. Correlate ex-vivo IV MR imaging
of human atherosclerosis with
matched histopathologic sections.
2. Show feasibility for in-vivo IV MR
imaging in rabbit model of aortic
atherosclerosis.
3. Show feasibility and safety for in-
vivo IV MR imaging of human iliac and
aorta atherosclerosis, before
proceeding to coronary arteries.
4. Demonstrate difficulties of plaque
identification and imaging techniques.
Oil-red-O
(lipid)
Picosirius
(collagen)
Surface
coil
R
2
= 0.9655
0
0.2
0.4
0.6
0.8
1
1.2
1.4
0 0.5 1 1.5
Seri es1
Li near (Seri es1)
Sensitivity Specificity
MRI score 1.4
(Fibrous)
83% 81%
1.4>MRI score0.5
(Lipid)
73% 85%
MRI score<0.5
(Calcium)
100% 97%
1. Ex-vivo Human Arterial Specimen
Structures were identified on
histology
fibrous component
lipid component
calcification
4 blinded readers scored intensity
relative to formalin and styrofoam on PD-,
T1-, mild T2-, and heavy T2-weightings.
Scores weighted and combined into single
number for each structure.
2. In-vivo IV MR of Rabbit Aortic Atherosclerosis
Normal Aorta Mild Disease
Moderate
Disease
Severe Disease
MRI H & E
T1 SE
Rabbit 19
Frequency
L/R
Frequency
A/P
n
n
Frequency
A/P
n
Frequency
A/P
n
IV coil
Early Atherosclerosis
Lumen area(N=37, r=0.96)
Correlation Between IV MRI and Histology
Lumen area( r=0.96)
Vulnerable Plaques Cause
Atherosclerotic Events
Aims
Motivation for IV
MR Imaging
Identification and Characterization of
Atherosclerotic Plaques with an
Intravascular MRI Coil

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