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Early Diabetic Vessel Wall Disease Detection and Characterization With Magnetic Resonance Imaging

Measurement of vessel wall disease using contours
Measurement of vessel wall disease using contours

Diabetes is a globally increasing burden that has a heavy impact on health care systems (Interact Cardiovasc Thorac Surg. 2013;16;339–46). Ever-rising prevalence rates of diabetes lead to increased vascular complications synonymous with the disease (Can J Diabetes. 2013; 37(suppl 1);S1–S212). Increased risk of cardiovascular disease and accelerated atherosclerotic development increases vulnerability of diabetic patients to their clinical endpoints (Cell Metab. 2013;17;20–33). As a result, 80% of deaths within this population are due mainly to ischemic coronary and cerebrovascular events (Statistics Canada, CANSIM Table 102-0529, 2007–2011).

Current guidelines use carotid artery stenosis to estimate atherosclerotic plaque burden and determine intervention (Stroke. 1999;30;1751–58). However, there is increasing evidence that plaque morphology plays an important role in predicting future cerebrovascular events, regardless of stenosis. Imaging and measurement of the plaque and its components have become possible, in vivo, using magnetic resonance imaging (MRI). Intraplaque hemorrhage is thought to drive atherosclerotic plaque progression, leading to plaque destabilization and disruption and resulting in ischemic strokes (Cardiovasc Imaging. 2012;5;406–8). Similarly, other plaque components, such as calcium and the lipid-rich necrotic core, are useful in staging atherosclerosis and contribute to prediction of future events.

From this database of asymptomatic, type 2 diabetic patients without evidence of carotid artery disease, we aim to identify the prevalence of complicated atherosclerotic lesions, specifically intraplaque hemorrhage within this population. These patients will have MRI and ultrasound performed at baseline and repeat imaging after one and three years. Using this, we also aim to measure plaque progression and observe the impact that the atherosclerotic plaque components may have on overall disease. The technical aspects of vessel wall measurement reproducibility and plaque component identification will also be addressed.