MRI-based biomechanical parameters for carotid artery plaque vulnerability assessment

Lambert Speelman; Zhongzhao Teng; Aart J. Nederveen; Aad Van der Lugt; Jonathan H. Gillard

doi:10.1160/th15-09-0712

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(03): 493-500
DOI: 10.1160/th15-09-0712

Theme Issue Article

Schattauer GmbH

MRI-based biomechanical parameters for carotid artery plaque vulnerability assessment

Lambert Speelman

¹Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands

,

Zhongzhao Teng

²Department of Radiology, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK

,

Aart J. Nederveen

³Department of Radiology, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands

,

Aad Van der Lugt

⁴Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands

,

Jonathan H. Gillard

²Department of Radiology, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK

› Author Affiliations

Abstract

Summary

Carotid atherosclerotic plaques are a major cause of ischaemic stroke. The biomechanical environment to which the arterial wall and plaque is subjected to plays an important role in the initiation, progression and rupture of carotid plaques. MRI is frequently used to characterize the morphology of a carotid plaque, but new developments in MRI enable more functional assessment of carotid plaques. In this review, MRI based biomechanical parameters are evaluated on their current status, clinical applicability, and future developments. Blood flow related biomechanical parameters, including endothelial wall shear stress and oscillatory shear index, have been shown to be related to plaque formation. Deriving these parameters directly from MRI flow measurements is feasible and has great potential for future carotid plaque development prediction. Blood pressure induced stresses in a plaque may exceed the tissue strength, potentially leading to plaque rupture. Multi-contrast MRI based stress calculations in combination with tissue strength assessment based on MRI inflammation imaging may provide a plaque stress-strength balance that can be used to assess the plaque rupture risk potential. Direct plaque strain analysis based on dynamic MRI is already able to identify local plaque displacement during the cardiac cycle. However, clinical evidence linking MRI strain to plaque vulnerability is still lacking. MRI based biomechanical parameters may lead to improved assessment of carotid plaque development and rupture risk. However, better MRI systems and faster sequences are required to improve the spatial and temporal resolution, as well as increase the image contrast and signal-to-noise ratio.

Keywords

Atherosclerosis - inflammation - MRI - biomechanics

Full Text

References

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