Virtual Angioscopy for the Assessment of Atherothrombosis
Juan F. Viles-Gonzaleza,b, Teresa Riusb, Javier Sanzb, Konstantin Nikolaoub, Zahi A. Fayadb, Valentin Fusterb, Michael Poonb, Juan J. Badimona
aCardiovascular Biology Research Laboratory, bThe Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA.
Address for correspondence: Dr Juan J. Badimon. Director, Cardiovascular Biology Research Laboratory, Cardiovascular Institute, Box 1030. One Gustave L. Levy Place Mount Sinai School of Medicine, New York, NY 10029. Phone: +1 212 241 8484, Facsimile: +1 212 426 6962, Email: juan.badimon@mssm.edu
Acknowledgement: This study was supported by grants from the National Institutes of Health (National Institutes of Health Specialized Center of Research grant HL54469, Drs Fuster and Badimon); the National Heart, Lung and Blood Institute (HL61801, Dr Fuster).
New non-invasive cardiac imaging modalities, such as 16-slice multi-detector-row computed tomography (MDCT) and magnetic resonance imaging (MRI), are bringing atherothrombosis out of the shadows and into the light (Figure 1). In an experimental model of carotid thrombosis we tested the capabilities of virtual angioscopy using fly-through (FT) with MDCT. A severe narrowing of the lumen was visualised during FT of the carotid artery, and the post-processing vessel analysis depicted a minimal lumen diameter of 0.44 mm that represented an 82% stenosis (Figure 1 and Movie). When compared to MRI, both localisation and characteristics of the lesion demonstrated an excellent agreement. Our data suggest that the combination of FT with post-processing vessel analysis allows precise identification of luminal diameter changes. However, it seems to have limited utility in the detection of non-stenotic, non-calcified atherosclerotic plaques. It is probable that further experience and probably improved post-processing software are required before FT can be introduced into daily clinical cardiology.
Figure legend
Figure 1. Acute thrombotic lesion. Panel A shows a severe stenosis (SS) of the right carotid artery (RC) caused by an acute thrombotic lesion. Panel B illustrates a picture of the virtual angioscopy using Fly-Through (FT) that detected a severe luminal narrowing caused by the thrombotic lesion (red arrow). We studied the same lesion with MRI (Panel C). The time of flight image shows the same localisation and characteristics of the lesion (black arrows). The post-processing vessel analysis allows the quantification of the degree of stenosis and calculates both maximum and minimum diameters and areas (Panel D).
RJ = right jugular; RS = right subclavian; LC = left carotid; LS = left subclavian.
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