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Screening for Atherosclerosis with Magnetic Resonance Imaging and Ultrasound
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Atherosclerosis is a major cause of death and disability worldwide. Although traditional risk factors can identify the healthy or severely affected individuals, sudden lethal outcome is still frequent in those suggested as intermediate in risk for cardiovascular events (CVE). Adding imaging to the traditional scoring systems might improve risk stratification.

This thesis investigates whether the addition of magnetic resonance imaging (MRI) and ultrasound (US) to traditional risk factors might render atherosclerosis suitable for mass screening, selective screening or screening in research settings.

In paper I the carotid arteries were assessed in six different manners (carotid intima media thickness (CIMT) in two different locations, presence of plaque, number of plaques, plaque size and plaque composition) using US. More than 800 Caucasian subjects were assessed at ages 70 and 75, and outcome examined at 80 years of age. Plaques with an area exceeding 10mm2 in the bulb were found to be most closely related to CVE.

Paper II established that carotid plaque volume measured with MRI did not correlate with carotid plaque area assessed with US. MRI reached the highest levels of reproducibility of the two methods.

Paper III used the previously created total atherosclerotic score (TAS), a scoring system based on whole body magnetic resonance angiography (WBMRA) that assesses global atherosclerosis. TAS was found to predict CVE in 305 PIVUS-subjects at age 70 years during 5 years of follow-up. The risk for CVE was found to be eightfold with TAS>0.

In paper IV CIMT was assessed with US at ages 70 and 75 years. CIMT at baseline, but not the change in CIMT over five years, was significantly related to TAS, thus suggesting carotid changes to correlate with atherosclerosis throughout the body.

In conclusion, in research settings WBMRA and MRI, as well as US, can be used for screening and following up of atherosclerotic changes, as their predictive values and reproducibility are good. US might be feasible in selective screening but none of these methods are as of now suitable for mass screening.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 81 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1074
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:uu:diva-246166ISBN: 978-91-554-9179-6 (print)OAI: oai:DiVA.org:uu-246166DiVA: diva2:792115
Public defence
2015-04-17, Rosénsalen, ingång 95/96, Akademiska Sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2015-03-27 Created: 2015-03-03 Last updated: 2015-04-17
List of papers
1. A comparison between different indices of carotid artery atherosclerosis at ultrasound regarding risk of incident myocardial infarction and stroke
Open this publication in new window or tab >>A comparison between different indices of carotid artery atherosclerosis at ultrasound regarding risk of incident myocardial infarction and stroke
2015 (English)Article in journal (Other academic) Submitted
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-246164 (URN)
Available from: 2015-03-03 Created: 2015-03-03 Last updated: 2015-04-27Bibliographically approved
2. Measuring carotid plaque size in asymptomatic individuals: comparison and reproducibility of MRI and B-mode ultrasound
Open this publication in new window or tab >>Measuring carotid plaque size in asymptomatic individuals: comparison and reproducibility of MRI and B-mode ultrasound
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-246163 (URN)
Available from: 2015-03-03 Created: 2015-03-03 Last updated: 2015-04-17
3. Total atherosclerotic burden by whole body magnetic resonance angiography predicts major adverse cardiovascular events
Open this publication in new window or tab >>Total atherosclerotic burden by whole body magnetic resonance angiography predicts major adverse cardiovascular events
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2013 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 228, no 1, 148-152 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

The purpose of the present study was to investigate the relationship between the Total Atherosclerotic Score (TAS), a measurement of the overall atherosclerotic burden of the arterial tree by whole body magnetic resonance angiography (WBMRA), and the risk of major adverse cardiovascular events (MACE), defined as cardiac death, myocardial infarction, stroke and/or coronary revascularization, assuming that TAS predicts MACE.

METHODS AND RESULTS:

305 randomly selected 70 year-old subjects (47% women) underwent WBMRA. Their atherosclerotic burden was evaluated and TAS > 0, that is atherosclerotic changes, were found in 68% of subjects. During follow-up (mean 4.8 years), MACE occurred in 25 subjects (8.2%). Adjusting for multiple risk factors, TAS was associated with MACE (OR 8.86 for any degree of vessel lumen abnormality, 95%CI 1.14-69.11, p = 0.037). In addition, TAS improved discrimination and reclassification when added to the Framingham risk score (FRS), and ROC (Receiver Operator Curve) increased from 0.681 to 0.750 (p = 0.0421).

CONCLUSION:

In a population-based sample of 70 year old men and women WBMRA, with TAS, predicted MACE independently of major cardiovascular risk factors.

National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-197476 (URN)10.1016/j.atherosclerosis.2013.02.015 (DOI)000318567000022 ()23474127 (PubMedID)
Available from: 2013-03-26 Created: 2013-03-26 Last updated: 2017-12-06Bibliographically approved
4. The relationship between carotid intima-media thickness and global atherosclerosis
Open this publication in new window or tab >>The relationship between carotid intima-media thickness and global atherosclerosis
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2014 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 34, no 6, 457-462 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

The aim of this study was to investigate the relationship between (i) carotid intima-media thickness (CIMT) at baseline as well as (ii) change in CIMT over 5 years (ΔCIMT) and atherosclerotically induced luminal narrowing in non-coronary arterial territories assessed by whole-body magnetic resonance angiography (WBMRA).

METHODS AND RESULTS:

In subgroups of the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS) study, US measurements of CIMT in the common carotid arteries were analysed at 70 and 75 years and ΔCIMT was calculated (n = 272). WBMRA, assessing arterial stenosis in five different territories by which also a total atherosclerotic score (TAS) was calculated, was performed at 70 years (n = 306).

RESULTS:

Carotid intima-media thickness in the carotid artery at baseline was correlated with TAS (P = 0·0001) when adjusted to a set of traditional risk factors for atherosclerosis, as well as to stenosis in two of the different investigated territories (aorta and lower leg, P = 0·013 and P = 0·004), but there was no significant correlation between ΔCIMT and TAS (P = 0·41).

CONCLUSIONS:

In the present study, CIMT, but not ΔCIMT over 5 years, in the carotid artery was related to overall stenoses in the body, as assessed by WBMRA. These findings support CIMT as a general marker for atherosclerosis.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-221885 (URN)10.1111/cpf.12116 (DOI)000345639300006 ()24405735 (PubMedID)
Available from: 2014-04-07 Created: 2014-04-07 Last updated: 2017-12-05Bibliographically approved

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