C004 (Subject CG)-Right CarotidC004 (Subject CG)-Right Carotid• Review of the patient diagnosis • In vivo image data• Tissue matching between in-vivo and ex-vivo MRI.• Matching MR and CT • Ex-vivo and PCA• Manual labeling • 3-D reconstruction• Example labeled slices, with raw data, labeled• Data and histology• Issues and Questions

Ron Wolf’s DiagnosisRon Wolf’s Diagnosis

• Probably primarily Type VII plaque, heavily calcified distal CCA/bulb with distal CCA fibrous tissue laterally

• High grade focal stenosis• Bifurcation at about C3-4

AVPAS (Automated Vulnerable Plaque Assessment System) AVPAS (Automated Vulnerable Plaque Assessment System)

This slide shows multi-contrast MR images of four slices. This image sequence served as a check matching those provided to us by Ron Wolf for this subject (C004/CG).

Ron’s version is shown on the following slide).

TOF slices were shifted in the z-axis to achieve column-wise alignment.

MR 1/5/04 (From Ron)MR 1/5/04 (From Ron)

T1W (multislice)

PDW(multislice)

TOF

1/5/04 MRI

Matching Ex-vivo and In-Vivo ImagesMatching Ex-vivo and In-Vivo Images

CaCa

Ex-vivo MRI Slice In-vivo TOF MR slice 4 of 12.

* *

Notes1. Red asterisk indicates a morphological landmark common to in-vivo and ex-vivo, the tail-like

structure of the lumen. Lumen is indicated by ‘L’.2. Intimal calcium surrounds the lumen ‘tail’. Fiberous tissue encases much the calcium.

L

L

This figure shown is from Yuan’s This figure shown is from Yuan’s In-Vivo Accuracy In-Vivo Accuracy of Multispectral Magnetic Resonance Imaging for of Multispectral Magnetic Resonance Imaging for Identifying Lipid Rich Necrotic CoreIdentifying Lipid Rich Necrotic Core. It displays a . It displays a pathology appearing similar to c004: large intimal pathology appearing similar to c004: large intimal calcifications protruding into the lumen, giving the calcifications protruding into the lumen, giving the TOF a mis-shapen ‘tail’ flow area. TOF a mis-shapen ‘tail’ flow area.

The close resemblance in shape and composition The close resemblance in shape and composition suggests similar stages of the disease and provided suggests similar stages of the disease and provided guidance in labeling.guidance in labeling. Ex-vivo and in-vivo (TOF) MR

Tissue Matching Ex-vivo and In-Vivo ImagesTissue Matching Ex-vivo and In-Vivo Images

Finding a match between CT and MRI proved to be difficult for subject C004. Landmarks are indicated by :

Asterisk - Calcium nodule‘L’ – Lumen‘D’ – Disrupted, broken tissue

-C004 CT was sent to us in Analyze format and seemed to suffer a loss in contrast relative to the CT scans sent to us in tif format (truncation loss?).

As seen in the 2 CT images shown below, the data was examined with 2 different tools: MRIcro and GEHC Microview

In-vivo and ex-vivo MRI

Ca

Ca

***

*L

L

D

CT using MRIcro CT using GEHC MicroView

Matching CT and MRMatching CT and MR

Matching Ex-vivo and CT ImagesMatching Ex-vivo and CT Images

This figure is taken from Ron’s Mineral Volume and Morphology if Carotid Plaque It shows close agreement between MR and CT for what appears to be subject c004. Duplicating this match proved to be difficult.

C004 Ex-vivo MRI Slices 5-9 and PCAC004 Ex-vivo MRI Slices 5-9 and PCA

ThisThis slide shows all slide shows all of the contrast of the contrast weightings for ex-weightings for ex-vivo slices 5-9.vivo slices 5-9.The column on the The column on the right side shows an right side shows an RGB overlay of the RGB overlay of the first three principle first three principle components PCA components PCA

Labeling and Classifying Lesion TypesLabeling and Classifying Lesion Types

The tables shown above and to the right provide labeling references for classifying tissues and AHA disease stages according to MR appearance.

1 2 3 4

5 6 7 8

Consecutive 3D TOF SectionsFlow Gap

lumen

Calcium (black)

C004 Left Carotid Labeling and Notes from RonC004 Left Carotid Labeling and Notes from Ron

Labeling of slide with Lumen ‘Tail’Labeling of slide with Lumen ‘Tail’

LegendLegend

Lumen: RedLumen: RedFibrous Tissue: BlueFibrous Tissue: BlueCalcium: whiteCalcium: whiteWall: GreenWall: Green

Note: Note: The following The following slide shows the slices slide shows the slices without the labelingwithout the labeling

Slice shown without labelingSlice shown without labeling

Labelings on Multiple SlicesLabelings on Multiple Slices

This screen shot shows the labels overlayed on the gray scale MR images. Unfortunately, the tools lacks a satisfactory dot size makes to show the label without obscuring the image. In this screen shot the labels appear as very vague clouds of red, green, blue and white dots.

3D Rendering of Labels3D Rendering of Labels LegendLegend

Lumen: Red (solid) Lumen: Red (solid) Fibrous Tissue: Blue (transparent)Fibrous Tissue: Blue (transparent)Calcium: gray (solid)Calcium: gray (solid)Wall: transparentWall: transparent

These are 3D images of the labeled These are 3D images of the labeled tissue. The image on the right is tissue. The image on the right is shown without the fiberous tissue shown without the fiberous tissue so that calcium can be seen more so that calcium can be seen more clearly.clearly.

The labeling shows a nodule (or The labeling shows a nodule (or region of high calcium content) region of high calcium content) encased in fibrous tissue.encased in fibrous tissue.

Distal region questionDistal region question

These panels show an abrupt transition from fibrous tissue to lumen. Does this seem correct?