漫谈7 | 颈动脉管壁MRI成像发展史——研究者系列

2025-08-01 09:43:58 by admin 17

从不同维度看颈动脉MRI技术的发展史，有助于加深我们对整个历程的了解。


我们曾按时间线的角度，捋了一遍颈动脉管壁MRI成像技术的发展史（漫谈1 | 颈动脉管壁MRI成像发展史）：从体外到在体，从动物到人体，从髂动脉到颈动脉，从识别斑块成分到关联卒中风险，从成像技术的研发到标准化临床研究工具的发布，颈动脉MRI管壁成像技术愈发成熟，并不断在科研和临床发力，助力卒中防治事业。

我们也曾从临床应用的角度，简单总结了颈动脉管壁MRI成像技术的临床应用之路（漫谈3 | 颈动脉管壁MRI成像发展史）：

  • 首先，研究者证明了斑块特征（薄/破裂的纤维帽，大脂质核，斑块内出血）与临床事件相关（斑块进展、TIA，卒中等）；
  • 其次不同领域的专家对该技术的临床价值和经济效益广泛的分析与讨论，能使哪些人群受益(无症状患者 and 隐源性卒中患者）?受益形式如何体现（优化治疗方式）?受益多少（寿命延长or经济支出减少）;
  • 最后该技术逐步走进临床一线，不断积累应用经验，目前主要用于辅助医生诊断斑块性质，解决以下几个问题：斑块是不是高危？什么类型的高危？高危到什么程度？斑块需不需要治疗？需要什么样的治疗？治疗的效果如何？


我们也曾从研究主题出发，专项了解每一个细分技术的发展：


我们也曾从“研究者”的角度，汇总了Chun Yuan，Thomas S. Hatsukami和William Kerwin的一作论文（漫谈2 | 颈动脉管壁MRI成像发展史），研究思路可简单总结为：斑块负荷与成分（纤维帽、脂质坏死核和斑块内新生血管）的成像与识别→斑块内新生血管与炎症的关联→CASCADE的开发→不同场强的验证→临床应用价值的探索。
从以上系列文章不难发现，华盛顿大学血管影像实验室相关研究工作贡献了主要且重大的推动力。今天我们就直接从整个“研究组“出发，介绍一下其在颈动脉管壁成像史中的相关工作。总结下来，主要可以概括为两个部分：1）开发新的成像和后处理技术，用于易损斑块成像领域，以更好地理解中风的潜在病因；2）开发易损斑块风险评估工具（如评分流程和系统），帮助临床医生和研究人员评估血管壁的风险并预测临床事件。主要贡献和成果如下：
算法开发：开发了一套用于血管壁分析的算法，并将其集成到CASCADE 综合软件包中。为了优化该软件在临床医生和研究人员中的应用，研究组还 制定了 验证流程和工作流程，并积极推动 CASCADE 算法的商业化。这一算法最终被整合到 VPDiagnostics Inc. 的商业版本 PlaqueView 中，成为易损斑块成像领域的重要工具。这一领域的主要成果发表在以下文献中：

  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

临床研究：上面提到的颈动脉血管壁 MRI算法和 CASCADE 软件已广泛应用于临床关于动脉粥样硬化、高血压、炎症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.


临床试验：为确保图像处理方法的广泛适用性，以及单中心和多中心 MRI 影像研中测量的可重复性和再现性，研究组开发了一套影像试验管理系统（Vascular Trial System，VTS），并与 CASCADE 血管壁测量程序相结合，目前已在全球数十个多中心血管壁 MRI 研究中广泛应用。主要相关研究成果发表在以下文献中：

  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.

颅内动脉、外周动脉影像处理及其他：近年来，管壁成像技术不断在发展，如3D和人工智能的应用； 成像范围也不断在扩展，从颈动脉到颅内，再到外周； 临床事件也从卒中和缺血性心脏病等传统经典心脑血管事件拓展至血管相关认知障碍与痴呆等新兴领域。主要相关研究发表在以下文献中：

  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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