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漫談7 | 頸動(dòng)脈管壁MRI成像發(fā)展史——研究者系列

2025-08-01 09:43:58 by admin 41

從不同維度看頸動(dòng)脈MRI技術(shù)的發(fā)展史，有助于加深我們對(duì)整個(gè)歷程的了解。


我們?cè)?/span>按時(shí)間線的角度，捋了一遍頸動(dòng)脈管壁MRI成像技術(shù)的發(fā)展史（漫談1 | 頸動(dòng)脈管壁MRI成像發(fā)展史）：從體外到在體，從動(dòng)物到人體，從髂動(dòng)脈到頸動(dòng)脈，從識(shí)別斑塊成分到關(guān)聯(lián)卒中風(fēng)險(xiǎn)，從成像技術(shù)的研發(fā)到標(biāo)準(zhǔn)化臨床研究工具的發(fā)布，頸動(dòng)脈MRI管壁成像技術(shù)愈發(fā)成熟，并不斷在科研和臨床發(fā)力，助力卒中防治事業(yè)。

我們也曾從臨床應(yīng)用的角度，簡(jiǎn)單總結(jié)了頸動(dòng)脈管壁MRI成像技術(shù)的臨床應(yīng)用之路（漫談3 | 頸動(dòng)脈管壁MRI成像發(fā)展史）：

  • 首先，研究者證明了斑塊特征（薄/破裂的纖維帽，大脂質(zhì)核，斑塊內(nèi)出血）與臨床事件相關(guān)（斑塊進(jìn)展、TIA，卒中等）；
  • 其次不同領(lǐng)域的專家對(duì)該技術(shù)的臨床價(jià)值和經(jīng)濟(jì)效益廣泛的分析與討論，能使哪些人群受益(無癥狀患者 and 隱源性卒中患者）?受益形式如何體現(xiàn)（優(yōu)化治療方式）?受益多少（壽命延長(zhǎng)or經(jīng)濟(jì)支出減少）;
  • 最后該技術(shù)逐步走進(jìn)臨床一線，不斷積累應(yīng)用經(jīng)驗(yàn)，目前主要用于輔助醫(yī)生診斷斑塊性質(zhì)，解決以下幾個(gè)問題：斑塊是不是高危？什么類型的高危？高危到什么程度？斑塊需不需要治療？需要什么樣的治療？治療的效果如何？


我們也曾從研究主題出發(fā)，專項(xiàng)了解每一個(gè)細(xì)分技術(shù)的發(fā)展：


我們也曾從“研究者”的角度，匯總了Chun Yuan，Thomas S. Hatsukami和William Kerwin的一作論文（漫談2 | 頸動(dòng)脈管壁MRI成像發(fā)展史），研究思路可簡(jiǎn)單總結(jié)為：斑塊負(fù)荷與成分（纖維帽、脂質(zhì)壞死核和斑塊內(nèi)新生血管）的成像與識(shí)別→斑塊內(nèi)新生血管與炎癥的關(guān)聯(lián)→CASCADE的開發(fā)→不同場(chǎng)強(qiáng)的驗(yàn)證→臨床應(yīng)用價(jià)值的探索。
從以上系列文章不難發(fā)現(xiàn)，華盛頓大學(xué)血管影像實(shí)驗(yàn)室相關(guān)研究工作貢獻(xiàn)了主要且重大的推動(dòng)力。今天我們就直接從整個(gè)“研究組“出發(fā)，介紹一下其在頸動(dòng)脈管壁成像史中的相關(guān)工作。總結(jié)下來，主要可以概括為兩個(gè)部分：1）開發(fā)新的成像和后處理技術(shù)，用于易損斑塊成像領(lǐng)域，以更好地理解中風(fēng)的潛在病因；2）開發(fā)易損斑塊風(fēng)險(xiǎn)評(píng)估工具（如評(píng)分流程和系統(tǒng)），幫助臨床醫(yī)生和研究人員評(píng)估血管壁的風(fēng)險(xiǎn)并預(yù)測(cè)臨床事件。主要貢獻(xiàn)和成果如下：
算法開發(fā)：開發(fā)了一套用于血管壁分析的算法，并將其集成到CASCADE 綜合軟件包中。為了優(yōu)化該軟件在臨床醫(yī)生和研究人員中的應(yīng)用，研究組還 制定了 驗(yàn)證流程和工作流程，并積極推動(dòng) CASCADE 算法的商業(yè)化。這一算法最終被整合到 VPDiagnostics Inc. 的商業(yè)版本 PlaqueView 中，成為易損斑塊成像領(lǐng)域的重要工具。這一領(lǐng)域的主要成果發(fā)表在以下文獻(xiàn)中：

  1. Xu D, Hwang JN, Yuan C. Segmentation of multi-channel image with Markov random field based active contour model. Journal of Visual Signal Processing Systems, 2002;31:45-55.
  2. Kerwin W, Xu D, Liu F, Saam T, Underhill H, Takaya N, Chu B, Hatsukami T, Yuan C.  Magnetic resonance imaging of carotid atherosclerosis:  plaque analysis.  Topics in Magnetic Resonance Imaging, 2007; 18(5):371-378.
  3. Liu F, Xu D, Ferguson MS, Chu B, Saam T, Takaya N, Hatsukami TS, Yuan C, Kerwin WS.  Automated in vivo Segmentation of Carotid Plaque MRI with Morphology-Enhanced Probability Maps.  Magnetic Resonance in Medicine, 2006; 55(3):659-668.
  4. Yoneyama T, Sun J, Hippe DS, Balu N, Xu D, Kerwin WS, Hatsukami TS, Yuan C. “In vivo semi-automatic segmentation of multicontrast cardiovascular magnetic resonance for prospective cohort studies on plaque tissue composition: initial experience.” Int J Cardiovasc Imaging 2016 Jan 14;32(1):73-81.
  5. Liu J, Balu N, Hippe DS, Ferguson MS, Martinez-Malo V, DeMarco JK, Zhu DC, Ota H, Sun J, Xu D, Kerwin WS, Hatsukami TS, Yuan C. Semi-automatic carotid intraplaque hemorrhage detection and quantification on Magnetization-Prepared Rapid Acquisition Gradient-Echo (MP-RAGE) with optimized threshold selection. J Cardiovasc Magn Reson. 2016 Jul 16;18(1):41. PubMed PMID: 27430263; PubMed Central PMCID: PMC4950626.
  6. Chen L, Zhao H, Jiang H, Balu N, Geleri DB, Chu B, Watase H, Zhao X, Li R, Xu J, Hatsukami TS, Xu D, Hwang JN, Yuan C. Domain adaptive and fully automated carotid artery atherosclerotic lesion detection using an artificial intelligence approach (LATTE) on 3D MRI. Magn Reson Med. 2021 Sep;86(3):1662-1673. doi: 10.1002/mrm.28794. Epub 2021 Apr 22.
  7. Guo Y, Canton G, Chen L, Sun J, Geleri DB, Balu N, Xu D, Mossa-Basha M, Hatsukami TS, Yuan C. Multi-Planar, Multi-Contrast and Multi-Time Point Analysis Tool (MOCHA) for Intracranial Vessel Wall Characterization.， J Magn Reson Imaging. 2022 Sep;56(3):944-955. doi: 10.1002/jmri.28087. Epub 2022 Jan 31.PMID: 35099091

臨床研究：上面提到的頸動(dòng)脈血管壁 MRI算法和 CASCADE 軟件已廣泛應(yīng)用于臨床關(guān)于動(dòng)脈粥樣硬化、高血壓、炎癥和卒中等疾病的研究中。

  1. Saam T, Ferguson MS, Yarnykh VL, Takaya N, Xu D, Polissar NL, Hatsukami TS, Yuan C.  Quantitative evaluation of carotid plaque composition by in vivo MRI. Arteriosclerosis, Thrombosis and Vascular Biology, 2005; 25:234 - 239.
  2. Phan BA, Chu B, Kerwin WS, Xu D, Yuan C, Hatsukami T, Zhao XQ. Effect of contrast enhancement on the measurement of carotid artery lumen and wall volume using MRI. Journal of Magnetic Resonance Imaging, 2006, 23:481-485.
  3. Saam T, Cai JM, Cai YQ, An NY, Kampschulte A, Xu D, Kerwin WS, Takaya N, Polissar NL, Hatsukami TS, Yuan C. Carotid plaque composition differs between ethnic groups: a multi-contrast MRI study comparing mainland Chinese and American Caucasian patients. Arteriosclerosis, Thrombosis and Vascular Biology, 2005 25:611-616.
  4. Sun J, Canton G, Balu N, Hippe DS, Xu D, Liu J, Hatsukami TS, Yuan C. Blood Pressure Is a Major Modifiable Risk Factor Implicated in Pathogenesis of Intraplaque Hemorrhage: An In Vivo Magnetic Resonance Imaging Study. Arterioscler Thromb Vasc Biol. 2016 Feb 4. doi:pii: ATVBAHA.115.307043. [Epub ahead of print] PubMed [citation] PMID: 26848155
  5. Yamada K, Song Y, Sun J, Dong L, Xu D, Hippe DS, Yuan C. (2012). High intensity signal on MIP images from routine TOF-MRA of carotid atherosclerotic plaque indicates higher volume of intraplaque hemorrhage and lipid rich necrotic core. Journal of Cardiovascular Magnetic Resonance, 14(1), P133.
  6. Yamada K, Song Y, Hippe DS, Sun J, Dong L, Xu D, Yuan C. (2012). Quantitative evaluation of high intensity signal on MIP images of carotid atherosclerotic plaques from routine TOF-MRA reveals elevated volumes of intraplaque hemorrhage and lipid rich necrotic core. J Cardiovasc Magn Reson.
  7. Skeoch S, Hubbard P, Williams H, Xu D, Sun J, Balu N, Zhang W, James J, Hatsukami TS, Yuan C. Imaging Atherosclerotic Plaque Inflammation In RA: Methodology and Initial Findings In a Single Centre Cohort. Arthritis Rheum 2013;65 Suppl 10 :1941 DOI: 10.1002/art.2013.65.issue-s10.
  8. Xu D, Hippe DS, Underhill HR, Oikawa-Wakayama M, Dong L, et al. Prediction of high-risk plaque development and plaque progression with the carotid atherosclerosis score. JACC Cardiovasc Imaging. 2014 Apr;7(4):366-73. PubMed PMID: 24631510; PubMed Central PMCID: PMC4046843.
  9. Qiao H, He Q, Chen Z, Xu D, Huang L, He L, Jiang L, Li R, Luo J, Yuan C, Zhao X. Identification of early atherosclerotic lesions in carotid arteries with quantitative characteristics measured by 3D MRI. J Magn Reson Imaging. 2016 Apr 15;PubMed PMID: 27079951.
  10. Han T, Paramsothy P, Hong J, Isquith D, Xu D, Bai H, Neradilek M, Gill E, Zhao XQ. High-resolution MRI assessed carotid atherosclerotic plaque characteristics comparing men and women with elevated ApoB levels.  Int J Cardiovasc Imaging. 2020 Mar;36(3):481-489. doi: 10.1007/s10554-019-01600-1. Epub 2020 Feb 4.PMID: 32020410
  11. Sun J, Mossa-Basha M, Canton G, Balu N, Guo Y, Chen L, Xu D, Hippe DS, Pimentel KD, Hatsukami TS, Yuan C. Characterization of non-stenotic plaques in intracranial arteries with multi-contrast, multi-planar vessel wall image analysis. J Stroke Cerebrovasc Dis. 2022 Oct;31(10):106719. doi: 10.1016/j.jstrokecerebrovasdis.2022.106719. Epub 2022 Aug 19.


臨床試驗(yàn)：為確保圖像處理方法的廣泛適用性，以及單中心和多中心 MRI 影像研中測(cè)量的可重復(fù)性和再現(xiàn)性，研究組開發(fā)了一套影像試驗(yàn)管理系統(tǒng)（Vascular Trial System，VTS），并與 CASCADE 血管壁測(cè)量程序相結(jié)合，目前已在全球數(shù)十個(gè)多中心血管壁 MRI 研究中廣泛應(yīng)用。主要相關(guān)研究成果發(fā)表在以下文獻(xiàn)中：

  1. Yuan C, Kerwin WS, Yarnykh VL, Cai J, Saam T, Chu B, Takaya N, Ferguson MS, Underhill H, Xu D, Liu F, Hatsukami TS. MRI of atherosclerosis in clinical trials. Nuclear Magnetic Resonance in Biomedicine, 2006, 19:636-65.
  2. Saam T, Hatsukami TS, Yarnykh VL, Hayes CE, Underhill H, Chu B, Takaya N, Cai J, Kerwin WS, Xu D, Polissar NL, Neradilek B, Hamar WK, Maki J, Shaw DW, Buck R, Wyman B, Yuan C. Reader and platform reproducibility for quantitative assessment of carotid atherosclerotic plaque using 1.5T Siemens, Philips, and General Electric scanners. Journal of Magnetic Resonance Imaging, 2007;26(2):344-52.
  3. Underhill HR, Yarnykh VL, Hatsukami TS, Wang J, Balu N, Hayes CE, Oikawa M, Yu W, Xu D, Chu B, Wyman BT, Polissar NL, Yuan C.  Carotid plaque morphology and composition: initial comparison between 1.5- and 3.0-T magnetic field strengths.  Radiology. 2008:248(2):550-560.
  4. Sun J, Balu N, Hippe DS, Xue Y, Dong L, Zhao X, Li F, Xu D, Hatsukami TS, Yuan C., Subclinical carotid atherosclerosis: short-term natural history of lipid-rich necrotic core--a multicenter study with MR imaging. Radiology. 2013 Jul;268(1):61-8. doi: 10.1148/radiol.13121702. Epub 2013 Mar 19.  PMID:  23513240.
  5. Beddhu S, Boucher RE, Sun J, Balu N, Chonchol M, Navaneethan S, Chertow GM, Townsend R, Haley W, Cheung AK, Conroy MB, Raj DS, Xu D, George T, Yunis R, Wei G, Canton G, Bates J, Chen J, Papademetriou V, Punzi H, Wiggers A, Wright JT, Greene T, Yuan C.  Chronic kidney disease, atherosclerotic plaque characteristics on carotid magnetic resonance imaging, and cardiovascular outcomes. BMC Nephrol. 2021 Feb 24;22(1):69. doi: 10.1186/s12882-021-02260-x.

顱內(nèi)動(dòng)脈、外周動(dòng)脈影像處理及其他：近年來，管壁成像技術(shù)不斷在發(fā)展，如3D和人工智能的應(yīng)用； 成像范圍也不斷在擴(kuò)展，從頸動(dòng)脈到顱內(nèi)，再到外周； 臨床事件也從卒中和缺血性心臟病等傳統(tǒng)經(jīng)典心腦血管事件拓展至血管相關(guān)認(rèn)知障礙與癡呆等新興領(lǐng)域。主要相關(guān)研究發(fā)表在以下文獻(xiàn)中：

  1. McDermott MM, Liu K, Carroll TJ, Tian L, Ferrucci L, Li D, Carr J, Guralnik JM, Kibbe M, Pearce WH, Yuan C, McCarthy W, Kramer CM, Tao H, Liao Y, Clark ET, Xu D, Berry J, Orozco J, Sharma L, Criqui MH. “Superficial femoral artery plaque and functional performance in peripheral arterial disease: walking and leg circulation study (WALCS III).” JACC Cardiovasc Imaging. 2011 Jul;4(7):730-9.
  2. McDermott MM, Liu K, Carr J, Criqui MH, Tian L, Li D, Ferrucci L, Guralnik JM, Kramer CM, Yuan C, Kibbe M, Pearce WH, Berry J, McCarthy W, Liao Y, Xu D, Orozco J, Carroll TJ. “Superficial femoral artery plaque, the ankle-brachial index, and leg symptoms in peripheral arterial disease: the walking and leg circulation study (WALCS) III.“ Circ Cardiovasc Imaging. 2011 May;4(3):246-52.
  3. McDermott MM, Carr J, Liu K, Kramer CM, Yuan C, Tian L, Criqui MH, Guralnik JM, Ferrucci L, Zhao L, Xu D, Kibbe M, Berry J, Carroll TJ. “Collateral vessel number, plaque burden, and functional decline in peripheral artery disease.” Vasc Med. 2014 Jul 21;19(4):281-288.
  4. Polonsky TS, Liu K, Tian L, Carr J, Carroll TJ, Berry J, Criqui MH, Ferrucci L, Guralnik JM, Kibbe MR, Kramer CM, Li F, Xu D, Zhao X, Yuan C, McDermott MM.” High-risk plaque in the superficial femoral artery of people with peripheral artery disease: Prevalence and associated clinical characteristics.” Atherosclerosis. 2014 Sep 2;237(1):169-176.
  5. Chen Z, Liu W, Balu N, et al. Associations of Intracranial Artery Length and Branch Number on Time-of-Flight MRA With Cognitive Impairment in Hypertensive Older Males. J Magn Reson Imaging. 2024;60(4):1720-1728. doi:10.1002/jmri.29242
  6. Guo Y, Canton G, Baylam Geleri D, et al. Plaque Evolution and Vessel Wall Remodeling of Intracranial Arteries: A Prospective, Longitudinal Vessel Wall MRI Study. J Magn Reson Imaging. 2024;60(3):889-899. doi:10.1002/jmri.29185



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