Table Of ContentLuca Saba · João Miguel Sanches
Luís Mendes Pedro · Jasjit S. Suri Editors
Multi-Modality
Atherosclerosis
Imaging and
Diagnosis
Multi-Modality Atherosclerosis Imaging
and Diagnosis
Luca Saba • Joa˜o Miguel Sanches
Lu´ıs Mendes Pedro (cid:129) Jasjit S. Suri
Editors
Multi-Modality
Atherosclerosis Imaging
and Diagnosis
123
Editors
LucaSaba Joa˜oMiguelSanches
DepartmentofRadiology InstituteforSystemsandRobotics
A.O.UCagliari-PolodiMonserrato InstitutoSuperiorTe´cnico
DiCagliariPoloDiMonserrato Lisboa,Portugal
BivioperSestu,Italy
JasjitS.Suri
Lu´ısMendesPedro StrokeResearchandMonitoringDivision
HospitaldeSantaMaria AtheroPoint(TM)LLC
Lisboa,Portugal Roseville,CAUSA
ISBN978-1-4614-7424-1 ISBN978-1-4614-7425-8(eBook)
DOI10.1007/978-1-4614-7425-8
SpringerNewYorkHeidelbergDordrechtLondon
LibraryofCongressControlNumber:2013942493
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Luca SabadedicatesthisbooktohisparentsGiovanniandRaffaelaSabawho
firsttaughthimtolovescience.
JasjitS. Suridedicatesthisbooktohisfamilyand collaboratorsaroundthe
world.
Foreword
Igladlyaccepttheinvitationtowriteafewwordsofpresentationtothisbookdedicatedtothe
diagnosisandtreatmentofatherosclerosiswithmultimodalityimagingprocedures.
The development of atherosclerotic carotid plaque and the plaque’s rupture as cause of
stroke requires a multidisciplinary approach; the imaging procedures represent the most
relevantpracticalmethodologytostudythisimportantclinicalproblem.
Over the nextyear improvementin instrumentationand radiopharmaceuticalscontributed
totheimportantgrowthofthisscientificfield.
In this volume the authors, in a remarkable international representation, present an
encyclopedic compilation of the more relevant methodological approaches in the study of
atherosclerosis. Special thanks go to the editors: Dr. Saba, Dr. Sanches, Dr. Pedro, and Dr.
Surifortheoutstandingcontributionsanddedications.
Thetextcomprises29chaptersorganizedintofivemajorsectionsdealingwithatheroscle-
rosisanatomyimaging,MRatherosclerosisimaging,CTatherosclerosisimaging,Ultrasound
AtherosclerosisImaging,andMolecularImagingandTherapy.
Thecontributors,well-knownauthorities,andyoungerauthorswhohaveachievedparticular
renowninspecializedaspects,arewellmatchedtopermiteachtopictobeconsideredindepth
andwithexpertise.Theyhavedefinedthetechnologyandidentifiedthemethodologyandareas
foritseffectiveapplication.
I feel confident that this volume will put a diagnostically significant specialty into
perspective to all physicians who deal with atherosclerosis imaging diagnosis. I express my
warmestcongratulationstotheauthorsforhavingtakenthatimportantscientificaim.
Cagliari,Italy MarioPiga
vii
Preface
Stroke is one of the leading causes of death in the world, resulting mostly from the
sudden ruptures of atherosclerosis carotid plaques. However, until now, the exact plaque
development/rupturemechanism has not been fully understood, and also the plaque rupture
risk stratification. From biomechanical viewpoint, plaque initiation and development could
be attributedto the disturbed flow in those arteries, and the suddenruptureof plaque can be
resultedfromplaquestructurestabilityfailuredueto the mechanicalstressin/outsideplaque
structure.Understandingthisphenomenonwhyandhowplaquedevelopsandrupturesrequires
a multidisciplinary approach such as radiology, biomedical engineering, medical physics,
softwareengineering,hardwareengineering,andpathologicalandhistologicalimaging.
This book presents a new dimension of understanding Atherosclerosis in 2D and 3D.
For example, Finite element/Finite volume models have been developed from 2D to 3D,
from idealized models to patient-specific plaques in terms of geometrical accuracy, from
structure/bloodflow analysis only to fluid structure interaction analysis in terms of physical
phenomenonreality.Recentstudieshavedemonstratedthatthepredictedstresscombinedwith
plaquemorphologicalfeaturescanbe usedforplaquerisk assessment,whichwill behelpful
in clinic. The book presents work on plaque stress analysis in order to provide a general
frameworkofcomputationalmodelingwithatherosclerosisplaques.
Anotherfieldinpredictingplaquedevelopmentisinunderstandingthe3Dfluiddynamics
and distributed flow pattern analysis with plaque morphological features. The book also
presents the atherosclerosis lesions with respect to the 3D geometry of the arteries due to
the resulted complex blood flow patterns, such as the regions with high curvature, or near
bifurcations.Computationalfluiddynamicbasedonpatient-specific3Dcarotidgeometrieswill
behelpfulinidentifyingtheareainriskandmightbeusedforpredictingplaquedevelopment.
Limited research has been devoted to advancing plaque stress analysis into the field of
patient-specific modeling; however, most existed studies on plaque stress analysis are not
patient-specific modeling due to the lack of patient-specific boundary condition or material
properties. Patient-specific modeling in plaque stress analysis still is a bit challenging in
the field. Recent studies have demonstrated that it is possible to obtain patient-specific
material model from in vivo human data, which enable plaque stress analysis to be much
closer to the real situation rather than a general material model from existed literatures or
obtained by ex vivo experiments. The book also presents the related difficulties in patient-
specific modeling for plaque stress analysis, and focus on patient-specific material property
characterizationbyusinginvivoMRIdata.Itisbelievedthattheprocedureofusingpatient-
specificmaterialmodelwillyieldmorerealisticplaquestresses,whichmayplayanimportant
roleinunderstandingplaquedevelopmentandrupture.
Much research has been devoted to studying plaque risk stratification by using modern
medicalimagingtechnologyforcharacterizationofplaqueburdens,includingstenosisdegree,
arterialwallthickness,etc.,andfurtherstudiesonmedicalimage-basedplaquemodeling,such
as plaque stress analysis. The first step for those studies is to accurately segment diseased
vascularstructuremanuallyorsemiauto/automatic.Semiautomaticsegmentationapplications
withtheabilityofmanualadjustmentandcorrectionbecomeparticularlyusefulintheclinical
applicationandresearchasrapidlyadvancingscannertechnologycapableofgeneratinglarger
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