Advertisement

Carotid intima–media and adventitial thickening: Comparison of new and established ultrasound and magnetic resonance imaging techniques

      Abstract

      Objective

      Carotid intima–media thickness is a well established non-invasive surrogate marker of cardiovascular disease, however there is evidence that structural modification of the arterial adventitia also accompanies cardiovascular risk factors and might be involved causally in atherosclerosis. We sought to determine the relative contributions of the intima–media and adventitia to variation in ultrasound and magnetic resonance derived measures of carotid wall thickness.

      Methods

      Carotid ultrasound and magnetic resonance imaging were undertaken in 20 participants. Carotid intima–media thickness, carotid extra–media thickness (which incorporates the arterial adventitia) and total wall thickness (a combined near-wall intima–media thickness and carotid extra–media thickness) using high-resolution ultrasound, and wall thickness using magnetic resonance imaging, were obtained.

      Results

      All ultrasound-derived measures of the arterial wall thickness were highly correlated with wall thickness by magnetic resonance imaging (all P < 0.001); as expected the total wall thickness by ultrasound measure was most tightly correlated (correlation coefficient = 0.814, P < 0.0001). In multivariable models, there was evidence that both carotid intima–media thickness and carotid extra–media thickness contributed independently to the variance in wall thickness by magnetic resonance imaging, especially for the most severe focal thickening. Measures of carotid wall thickness that incorporated all three layers of the arterial wall were more closely correlated with the number of cardiovascular risk factors than carotid intima–media thickness alone.

      Conclusions

      These results indicate that the arterial adventitia is an important contributor to the wall thickness measure derived by magnetic resonance imaging, and that carotid extra–media thickness likely provides additional information concerning arterial structure than that obtained from carotid intima–media thickness alone.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Michel J.B.
        • Thaunat O.
        • Houard X.
        • et al.
        Topological determinants and consequences of adventitial responses to arterial wall injury.
        Arterioscler Thromb Vasc Biol. 2007; 27: 1259-1268
        • Herrmann J.
        • Samee S.
        • Chade A.
        • et al.
        Differential effect of experimental hypertension and hypercholesterolemia on adventitial remodeling.
        Arterioscler Thromb Vasc Biol. 2005; 25: 447-453
        • Grabner R.
        • Lotzer K.
        • Dopping S.
        • et al.
        Lymphotoxin beta receptor signaling promotes tertiary lymphoid organogenesis in the aorta adventitia of aged ApoE−/− mice.
        J Exp Med. 2009; 206: 233-248
        • Skilton M.R.
        • Serusclat A.
        • Sethu A.H.
        • et al.
        Noninvasive measurement of carotid extra–media thickness: associations with cardiovascular risk factors and intima–media thickness.
        JACC Cardiovasc Imaging. 2009; 2: 176-182
        • Yudkin J.S.
        • Eringa E.
        • Stehouwer C.D.
        “Vasocrine” signalling from perivascular fat: a mechanism linking insulin resistance to vascular disease.
        Lancet. 2005; 365: 1817-1820
        • Schlett C.L.
        • Massaro J.M.
        • Lehman S.J.
        • et al.
        Novel measurements of periaortic adipose tissue in comparison to anthropometric measures of obesity and abdominal adipose tissue.
        Int J Obes (Lond). 2009; 33: 226-232
        • Boussel L.
        • Serusclat A.
        • Skilton M.R.
        • et al.
        The reliability of high resolution MRI in the measurement of early stage carotid wall thickening.
        J Cardiovasc Magn Reson. 2007; 9: 771-776
        • Mani V.
        • Aguiar S.H.
        • Itskovich V.V.
        • et al.
        Carotid black blood MRI burden of atherosclerotic disease assessment correlates with ultrasound intima–media thickness.
        J Cardiovasc Magn Reson. 2006; 8: 529-534
        • Crowe L.A.
        • Ariff B.
        • Keegan J.
        • et al.
        Comparison between three-dimensional volume-selective turbo spin-echo imaging and two-dimensional ultrasound for assessing carotid artery structure and function.
        J Magn Reson Imaging. 2005; 21: 282-289
        • Underhill H.R.
        • Kerwin W.S.
        • Hatsukami T.S.
        • Yuan C.
        Automated measurement of mean wall thickness in the common carotid artery by MRI: a comparison to intima–media thickness by B-mode ultrasound.
        J Magn Reson Imaging. 2006; 24: 379-387
        • Adams M.R.
        • Nakagomi A.
        • Keech A.
        • et al.
        Carotid intima–media thickness is only weakly correlated with the extent and severity of coronary artery disease.
        Circulation. 1995; 92: 2127-2134
        • Bernard S.
        • Serusclat A.
        • Targe F.
        • et al.
        Incremental predictive value of carotid ultrasonography in the assessment of coronary risk in a cohort of asymptomatic type 2 diabetic subjects.
        Diabetes Care. 2005; 28: 1158-1162
        • Gilbert R.E.
        • Rumble J.R.
        • Cao Z.
        • et al.
        Endothelin receptor antagonism ameliorates mast cell infiltration, vascular hypertrophy, and epidermal growth factor expression in experimental diabetes.
        Circ Res. 2000; 86: 158-165
        • Heistad D.D
        • Armstrong M.L.
        • Marcus M.L.
        Hyperemia of the aortic wall in atherosclerotic monkeys.
        Circ Res. 1981; 48: 669-675
        • Shi Y.
        • Pieniek M.
        • Fard A.
        • et al.
        Adventitial remodeling after coronary arterial injury.
        Circulation. 1996; 93: 340-348
        • Varnava A.M.
        • Mills P.G.
        • Davies M.J.
        Relationship between coronary artery remodeling and plaque vulnerability.
        Circulation. 2002; 105: 939-943
        • Lorenz M.W.
        • Markus H.S.
        • Bots M.L.
        • Rosvall M.
        • Sitzer M.
        Prediction of clinical cardiovascular events with carotid intima–media thickness: a systematic review and meta-analysis.
        Circulation. 2007; 115: 459-467
        • Falk E.
        • Thim T.
        • Kristensen I.B.
        Atherosclerotic plaque, adventitia, perivascular fat, and carotid imaging.
        JACC Cardiovasc Imaging. 2009; 2: 183-186
        • Chaldakov G.N.
        • Stankulov I.S.
        • Aloe L.
        Subepicardial adipose tissue in human coronary atherosclerosis: another neglected phenomenon.
        Atherosclerosis. 2001; 154: 237-238
        • Chaldakov G.N.
        • Tonchev A.B.
        • Stankulov I.S.
        • et al.
        Periadventitial adipose tissue (tunica adiposa): enemy or friend around?.
        Arch Pathol Lab Med. 2007; 131 (author reply 1766–1767)
        • O’Leary D.H.
        • Polak J.F.
        • Wolfson Jr., S.K.
        • et al.
        Use of sonography to evaluate carotid atherosclerosis in the elderly The Cardiovascular Health Study. CHS Collaborative Research Group.
        Stroke. 1991; 22: 1155-1163
        • Montauban van Swijndregt A.D.
        • The S.H.
        • Gussenhoven E.J.
        • et al.
        An in vitro evaluation of the line pattern of the near and far walls of carotid arteries using B-mode ultrasound.
        Ultrasound Med Biol. 1996; 22: 1007-1015
        • Wong M.
        • Edelstein J.
        • Wollman J.
        • Bond M.G.
        Ultrasonic-pathological comparison of the human arterial wall. Verification of intima–media thickness.
        Arterioscler Thromb. 1993; 13: 482-486
        • Espeland M.A.
        • Tang R.
        • Terry J.G.
        • et al.
        Associations of risk factors with segment-specific intimal–medial thickness of the extracranial carotid artery.
        Stroke. 1999; 30: 1047-1055