RESUMEN
Recently two independent meta-analyses on the efficacy of Cognitive Bias Modification of Interpretation (CBM-I) to reduce aggressive behavior came to different conclusions: Ciesinski et al. (2023) concluded that "CBM demonstrates efficacy for the treatment of aggressive behavior" (Abstract), whereas our research team concluded that "findings show limited support for the efficacy of CBM-I to reduce aggressive behavior" (AlMoghrabi et al., 2023, Discussion). How can similar meta-analyses reach such different conclusions? In this commentary, we raise awareness concerning how 1) seemingly identical research questions can be based on meaningfully different definitions of the intervention and outcomes; 2) intervention efficacy conclusions can depend on outcome assessment type; and 3) the interpretation of underpowered moderator analyses should not depend on statistical significance. We end our commentary with a third, more nuanced conclusion that can reconcile the two disparate conclusions: that current CBM-I is an effective experimental manipulation to modify interpretation biases, but not an effective stand-alone treatment to reduce aggressive behavior.
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Terapia Cognitivo-Conductual , Humanos , Agresión , Sesgo , Ira , CogniciónRESUMEN
This multicenter randomized controlled trial investigated whether interactive virtual reality enhanced effectiveness of Cognitive Behavioral Therapy (CBT) to reduce children's aggressive behavior problems. Boys with aggressive behavior problems (N = 115; Mage = 10.58, SD = 1.48; 95.7% born in Netherlands) were randomized into three groups: CBT with virtual reality, CBT with roleplays, or care-as-usual. Bayesian analyses showed that CBT with virtual reality more likely reduced aggressive behavior compared to care-as-usual for six of seven outcomes (ds 0.19-0.95), and compared to CBT with roleplays for four outcomes (ds 0.14-0.68). Moreover, compared to roleplays, virtual reality more likely enhanced children's emotional engagement, practice immersion, and treatment appreciation. Thus, virtual reality may be a promising tool to enhance CBT effectiveness for children with aggressive behavior problems.
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Terapia Cognitivo-Conductual , Realidad Virtual , Masculino , Humanos , Niño , Teorema de Bayes , Emociones , Países BajosRESUMEN
More than 45% of adolescents with aggressive behavior problems drop out of treatment prematurely. Building on insights from self-determination theory, we examined in three studies whether clinicians can raise adolescents' treatment engagement by supporting their autonomy. In an interview study (Study 1), clinicians (N = 16; 43.8% female; ages 30-57) spontaneously described 12 times more autonomy-supportive than controlling strategies to engage adolescents. In a preregistered experiment (Study 2), clinicians (N = 68; 88.2% female; ages 23-65) were confronted with videos of adolescents displaying resistance. We manipulated the DSM diagnosis of adolescents to indicate either aggressive behavior problems or other problems. We found that, regardless of diagnosis, clinicians used both autonomy-supportive strategies (57.7% of responses) and controlling strategies (39.3%), suggesting that applying autonomy support can be challenging with any adolescent displaying resistance. In an experimental study (Study 3), adolescents (N = 252; 50.0% female; ages 12-17) reported higher therapeutic alliance (d = 0.95, 95% CI [0.80, 1.10]) and treatment engagement (d = 0.77, 95% CI [0.63, 0.91]) after listening to audio-recorded autonomy-supportive versus controlling responses from clinicians, regardless of whether these adolescents had aggressive behavior problems. Overall, this research suggests that clinicians can raise adolescents' treatment engagement through autonomy support.
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Conducta del Adolescente , Problema de Conducta , Humanos , Adolescente , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Anciano , Niño , Masculino , Responsabilidad Parental , Relaciones Padres-Hijo , Autonomía Personal , Agresión , MotivaciónRESUMEN
Children with aggressive behavior problems may aggress for different reasons, requiring tailored assessment and treatment. The aim of this study was to test whether it is possible to detect distinct social information processing (SIP) profiles among boys with aggressive behavior problems. We therefore conducted Latent Profile Analyses on boys' SIP patterns assessed in interactive virtual reality. Additionally, we examined the discriminant validity of these SIP profiles by comparing them on theoretically relevant child characteristics (i.e., temperament, executive functioning, aggressive belief systems, punishment insensitivity, sensation seeking). We presented boys (N = 181; ages 7-13) with a virtual classroom where they could play games with virtual peers. They reported on their SIP in four virtual reality scenarios, designed to assess reactive and proactive aggressive SIP. Results revealed four distinct SIP profiles: a general reactive SIP profile, a situation-specific reactive SIP profile, a mixed reactive-proactive SIP profile, and a nonaggressive SIP profile. Planned contrasts revealed that boys with these SIP profiles differed in temperament, aggressive belief systems, and punishment insensitivity, but not in executive functioning and sensation seeking. Overall, findings suggest that boys differ in the exact SIP patterns underlying their aggressive behavior, providing inroads to tailor interventions to children's individual needs.
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Agresión , Cognición , Masculino , Niño , Humanos , Grupo Paritario , Función Ejecutiva , Temperamento , Conducta SocialRESUMEN
Interventions for children's aggression typically target assumed underlying mechanisms, such as anger regulation and hostile intent attribution. The expectation here is that targeting these mechanisms will result in within-person changes in aggression. However, evidence for these mechanisms is mostly based on between-person analyses. We, therefore, examined whether within-person changes in adaptive anger regulation and hostile intent attribution covaried with within-person changes in children's aggression. Children (N = 223; age 7-12; 46% boys) filled out four weekly report measures to assess adaptive anger regulation, hostile intent attribution, and aggression. The psychometric properties of these novel measures were adequate. Results of multi-level analyses revealed within-person effects: weekly changes in adaptive anger regulation and hostile intent attribution covaried with changes in children's aggression. This corresponded with between-person findings on the same data: children with lower levels of adaptive anger regulation and higher levels of hostile intent attribution reported more aggression than other children. These findings support the idea that targeting anger regulation and hostile intent attribution in interventions may lead to changes in individual children's aggression.
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Agresión , Hostilidad , Agresión/fisiología , Ira , Niño , Femenino , Humanos , Intención , Masculino , Percepción SocialRESUMEN
This study examined whether interactive Virtual Reality (VR) provides a more ecologically valid assessment of children's aggressive social information processing (SIP) and aggressive responses than a standard vignette-based assessment. We developed a virtual classroom where children could meet and play games with virtual peers. Participants were boys (N = 184; ages 7-13) from regular education and special education for children with disruptive behavior problems. They reported on their SIP in four scenarios (i.e., two instrumental gain and two provocation scenarios) presented through both interactive VR and vignettes. Teachers reported on children's real-life aggressive behavior and reactive and proactive motives for aggression. Results demonstrated that children found the interactive VR assessment more emotionally engaging and immersive than the vignette-based assessment. Moreover, compared to vignettes, the interactive VR assessment evoked higher levels of aggressive SIP and responses in provocation scenarios only. Results supported the enhanced predictive validity of the interactive VR assessment of children's aggressive SIP and responses, which predicted children's real-life aggression above and beyond the vignette-based assessment with 2 to 12% additional explained variance. Similar results were found for children's real-life reactive and proactive motives for aggression, with 3 to 12% additional variance explained by interactive VR above and beyond vignettes. Interactive VR did not, however, evoke larger individual differences (i.e., variances) in children's aggressive SIP and responses than vignettes. Together, these findings suggest that interactive VR provides a more ecologically valid method to assess children's aggressive SIP and responses than hypothetical vignettes.
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Problema de Conducta , Realidad Virtual , Adolescente , Agresión/psicología , Niño , Cognición , Femenino , Humanos , Masculino , Grupo ParitarioRESUMEN
BACKGROUND AND AIMS: Lipoprotein(a) is an independent risk factor for cardiovascular disease and recurrent ischemic stroke. Lipoprotein(a) levels are known to be associated with carotid artery stenosis, but the relation of lipoprotein(a) levels to carotid atherosclerotic plaque composition and morphology is less known. We hypothesize that higher lipoprotein(a) levels and lipoprotein(a)-related SNPs are associated with a more vulnerable carotid plaque and that this effect is sex-specific. METHODS: In 182 patients of the Plaque At RISK study we determined lipoprotein(a) concentrations, apo(a) KIV-2 repeats and LPA SNPs. Imaging characteristics of carotid atherosclerosis were determined by MDCTA (n = 161) and/or MRI (n = 171). Regressions analyses were used to investigate sex-stratified associations between lipoprotein(a) levels, apo(a) KIV-2 repeats, and LPA SNPs and imaging characteristics. RESULTS: Lipoprotein(a) was associated with presence of lipid-rich necrotic core (LRNC) (aOR = 1.07, 95% CI: 1.00; 1.15), thin-or-ruptured fibrous cap (TRFC) (aOR = 1.07, 95% CI: 1.01; 1.14), and degree of stenosis (ß = 0.44, 95% CI: 0.00; 0.88). In women, lipoprotein(a) was associated with presence of intraplaque hemorrhage (IPH) (aOR = 1.25, 95% CI: 1.06; 1.61). In men, lipoprotein(a) was associated with degree of stenosis (ß = 0.58, 95% CI: 0.04; 1.12). Rs10455872 was significantly associated with increased calcification volume (ß = 1.07, 95% CI: 0.25; 1.89) and absence of plaque ulceration (aOR = 0.25, 95% CI: 0.04; 0.93). T3888P was associated with absence of LRNC (aOR = 0.36, 95% CI: 0.16; 0.78) and smaller maximum vessel wall area (ß = -10.24, 95%CI: -19.03; -1.44). CONCLUSIONS: In patients with symptomatic carotid artery stenosis, increased lipoprotein(a) levels were associated with degree of stenosis, and IPH, LRNC, and TRFC, known as vulnerable plaque characteristics, in the carotid artery. T3888P was associated with lower LRNC prevalence and smaller maximum vessel wall area. Further research in larger study populations is needed to confirm these results.
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Estenosis Carotídea , Placa Aterosclerótica , Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Femenino , Humanos , Lipoproteína(a) , Imagen por Resonancia Magnética , Masculino , Factores de RiesgoRESUMEN
Evidence-based cognitive behavioral therapies (CBTs) for children with aggressive behavior problems have only modest effects. Research is needed into new methods to enhance CBT effectiveness. The aims of the present study were to (1) examine whether interactive virtual reality is a feasible treatment method for children with aggressive behavior problems; (2) investigate children's appreciation of the method; and (3) explore whether children's aggression decreased during the ten-session treatment. Six boys (8-12 years) participated at two clinical centers in the Netherlands. Newly developed weekly reports were collected on treatment feasibility (therapist-report), treatment appreciation (child report), and children's aggression (child/parent report). Results supported treatment feasibility: therapists delivered on average 98% of the session content, provided more than the recommended practice time in virtual reality, experienced few technical issues, and were satisfied with their treatment delivery. Children highly appreciated the treatment. Parents reported decreases in children's aggression over the treatment period (i.e., between week 1 and week 10), but children did not. The promising findings of this feasibility study warrant randomized controlled trials to determine whether interactive virtual reality enhances CBT effectiveness for children with aggressive behavior problems.
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Terapia Cognitivo-Conductual , Problema de Conducta , Realidad Virtual , Agresión , Niño , Estudios de Factibilidad , Humanos , MasculinoRESUMEN
Children's aggressive behaviour is partly determined by how they process social information (e.g., making hostile interpretations or aiming to seek revenge). Such aggressive social information processing (SIP) may be most evident if children are emotionally engaged in actual social interactions. Current methods to assess aggressive SIP, however, often ask children to reflect on hypothetical vignettes. This pilot study therefore examined a new method that actually involves children in emotionally engaging social interactions: interactive virtual reality (VR). We developed a virtual classroom where children could play games with virtual peers. A sample of boys (N = 32; ages 8-13) from regular and special education reported on their SIP in distinct VR contexts (i.e., neutral, instrumental gain and provocation). They also completed a standard vignette-based assessment of SIP. Results demonstrated good convergent validity of interactive VR assessment of SIP, as indicated by significant moderate to large correlations of VR-assessed SIP with vignette-assessed SIP for all SIP variables except anger. Interactive VR showed improved measurement sensitivity (i.e., larger variances in SIP compared to vignettes) for aggressive responding, but not for other SIP variables. Discriminant validity (i.e., distinct SIP patterns across contexts) of interactive VR was supported for provocation contexts, but not for instrumental gain contexts. Last, children were more enthusiastic about the VR assessment compared to the vignette-based assessment. These findings suggest that interactive VR may be a promising tool, allowing for the assessment of children's aggressive SIP in standardized yet emotionally engaging social interactions.
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Realidad Virtual , Adolescente , Agresión , Niño , Cognición , Humanos , Masculino , Grupo Paritario , Proyectos PilotoRESUMEN
The present study examined whether there are distinct groups of children with reactive versus proactive motives for their aggressive behavior. We extended previous research by using a person-based analytical approach on data from a questionnaire assessing children's motives independently from the severity of their aggression. Two competing hypotheses were tested. The both subtypes hypothesis holds that both reactive and proactive subtypes exist, as well as a mixed subtype. The reactive only hypothesis holds that only reactive and mixed subtypes exist. Hypotheses were tested on existing data from a community sample of children displaying aggression (Study 1: n = 228, ages 10-13, 54% boys), and two clinical samples of children with aggressive behavior problems (Study 2: n = 115, ages 8-13, 100% boys; Study 3: n = 123, ages 6-8, 78% boys). Teachers reported on children's reactive and proactive motives. We selected measures available from peers, parents, teachers, and children themselves to compare the supported subtypes on variables that previous literature suggests uniquely correlate with reactive versus proactive aggression. Confirmatory latent profile analyses revealed that the both subtypes hypothesis best fit the data of all three samples. Most children were classified as reactive (55.7-61.8% across samples), with smaller percentages classified as proactive (10.4-24.1%) and mixed (18.0-33.9%). However, these subtypes only differed in expected directions on 7 out of 34 measures. Overall, results support the existence of both reactive and proactive subtypes of aggressive children, but the distinctiveness of these subtypes in terms of social-emotional characteristics warrants further study.
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Agresión , Grupo Paritario , Adolescente , Niño , Emociones , Femenino , Humanos , Masculino , Motivación , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Vascular remodeling is a compensatory enlargement of the vessel wall in response to atherosclerotic plaque growth. We aimed to investigate the association between intraplaque hemorrhage (IPH), vascular remodeling, and luminal dimensions in recently symptomatic patients with mild to moderate carotid artery stenosis in which the differences in plaque size were taken into account. MATERIALS AND METHODS: We assessed vessel dimensions on MRI of the symptomatic carotid artery in 164 patients from the Plaque At RISK study. This study included patients with recent ischemic neurological event and ipsilateral carotid artery stenosis <70%. The cross section with the largest wall area (WA) in the internal carotid artery (ICA) was selected for analysis. On this cross section, the following parameters were determined: WA, total vessel area (TVA), and lumen area (LA). Vascular remodeling was quantified as the remodeling ratio (RR) and was calculated as TVA at this position divided by the TVA in an unaffected distal portion of the ipsilateral ICA. Adjustment for WA was performed to correct for plaque size. RESULTS: Plaques with IPH had a larger WA (0.56 vs. 0.46 cm2; p < 0.001), a smaller LA (0.17 vs. 0.22 cm2; p = 0.03), and a higher RR (2.0 vs. 1.9; p = 0.03) than plaques without IPH. After adjustment for WA, plaques containing IPH had a smaller LA (B = -0.052, p = 0.01) than plaques without IPH, but the RR was not different. CONCLUSION: After correcting for plaque size, plaques containing IPH had a smaller LA than plaques without IPH. However, RR was not different.
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Arteria Carótida Interna/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Hemorragia , Imagen por Resonancia Magnética , Placa Aterosclerótica , Remodelación Vascular , Anciano , Arteria Carótida Interna/patología , Estenosis Carotídea/patología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
Angiography Computerized Tomography (CT) Cerebrovascular disease/stroke Ischemic stroke Atherosclerosis Stenosis Thrombosis.
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Arterias Carótidas/patología , Enfermedades de las Arterias Carótidas/genética , Enfermedades de las Arterias Carótidas/metabolismo , Accidente Cerebrovascular/patología , Factor de von Willebrand/metabolismo , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Two experiments tested an intervention approach to reduce young children's hostile attribution bias and aggression: self-persuasion. Children with high levels of hostile attribution bias recorded a video-message advocating to peers why story characters who caused a negative outcome may have had nonhostile intentions (self-persuasion condition), or they simply described the stories (control condition). Before and after the manipulation, hostile attribution bias was assessed using vignettes of ambiguous provocations. Study 1 (n = 83, age 4-8) showed that self-persuasion reduced children's hostile attribution bias. Study 2 (n = 121, age 6-9) replicated this finding, and further showed that self-persuasion was equally effective at reducing hostile attribution bias as was persuasion by others (i.e., listening to an experimenter advocating for nonhostile intentions). Effects on aggressive behavior, however, were small and only significant for one out of four effects tested. This research provides the first evidence that self-persuasion may be an effective approach to reduce hostile attribution bias in young children.
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Agresión/fisiología , Conducta Infantil/fisiología , Hostilidad , Comunicación Persuasiva , Percepción Social , Niño , Preescolar , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Carotid atherosclerosis is an important cause of stroke. Intra-plaque haemorrhage (IPH) on magnetic resonance imaging (MRI) increases stroke risk. Development of IPH is only partly understood. Thrombin is an essential enzyme in haemostasis. Experimental animal studies have shown conflicting results on the relation between thrombin and plaque vulnerability. We hypothesize that decreased thrombin generation (TG) is associated with IPH and plaque vulnerability. OBJECTIVE: This article investigates whether TG is associated with IPH and other features of plaque vulnerability in stroke patients. METHODS: Recently symptomatic stroke patients underwent carotid MRI and blood sampling. MRI plaque features include plaque burden, presence of IPH, amount of lipid-rich necrotic core (LRNC), calcified tissue and fibrous tissue (% of total wall volume). TG was assessed in platelet-poor plasma and expressed as: peak height (PH) and endogenous thrombin potential (ETP). MR images could be analysed in 224 patients. Blood samples were available in 161 of 224 patients. Binary multivariate logistic and linear regression were used to investigate the association between TG and MRI plaque features. RESULTS: IPH and LRNC were present in 65 (40%) and 102 (63%) of plaques. There were no significant associations between TG and IPH; PH odds ratio (OR) = 1, 95% confidence interval (CI): 0.76 to 1.45 and ETP OR = 1, 95% CI: 0.73 to 1.37. After correction for age, sex and hypercholesterolaemia, the association was weak but non-significant; PH: OR = 0.76, 95% CI: 0.52 to 1.10 and ETP: OR = 0.73, 95% CI: 0.53 to 1.37. CONCLUSION: Features of carotid plaque on MRI show no significant association with TG in stroke patients. Systemic TG does not seem to be an important factor in IPH development.
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Estenosis Carotídea/complicaciones , Hemorragia/etiología , Placa Aterosclerótica , Accidente Cerebrovascular/etiología , Trombina/metabolismo , Anciano , Biomarcadores/sangre , Estenosis Carotídea/sangre , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/patología , Estudios Transversales , Progresión de la Enfermedad , Femenino , Fibrosis , Hemorragia/sangre , Hemorragia/diagnóstico por imagen , Hemorragia/patología , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Necrosis , Países Bajos , Medición de Riesgo , Factores de Riesgo , Rotura Espontánea , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/patología , Calcificación Vascular/complicaciones , Calcificación Vascular/patologíaRESUMEN
Two studies investigated whether parent-child discussion of peer provocations reduces young children's hostile attributional bias. Study 1 (N = 109, age 4-7)-an observational study-showed that parent-child discussion of nonhostile attributions (when reading a picture book) predicted reductions in children's hostile attributional bias from pre- to postdiscussion. Study 2 (N = 160, age 4-6)-an experimental study-showed that stimulating parents to discuss either nonhostile attributions or normative beliefs (vs. a control condition) reduced children's hostile attributional bias in response to hypothetical vignettes, but not in response to a staged peer provocation. These findings suggest that by framing social situations, parents may help their children perceive less hostility in their social worlds.
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Hostilidad , Relaciones Padres-Hijo , Percepción Social , Análisis de Varianza , Niño , Preescolar , Femenino , Humanos , Masculino , Padres , Grupo Paritario , Factores SociológicosRESUMEN
Some children who bully others are also victimized themselves ("bully-victims") whereas others are not victimized themselves ("bullies"). These subgroups have been shown to differ in their social functioning as early as in kindergarten. What is less clear are the motives that underlie the bullying behavior of young bullies and bully-victims. The present study examined whether bullies have proactive motives for aggression and anticipate to feel happy after victimizing others, whereas bully-victims have reactive motives for aggression, poor theory of mind skills, and attribute hostile intent to others. This "distinct processes hypothesis" was contrasted with the "shared processes hypothesis," predicting that bullies and bully-victims do not differ on these psychological processes. Children (n = 283, age 4-9) were classified as bully, bully-victim, or noninvolved using peer-nominations. Theory of mind, hostile intent attributions, and happy victimizer emotions were assessed using standard vignettes and false-belief tasks; reactive and proactive motives were assessed using teacher-reports. We tested our hypotheses using Bayesian model selection, enabling us to directly compare the distinct processes model (predicting that bullies and bully-victims deviate from noninvolved children on different psychological processes) against the shared processes model (predicting that bullies and bully-victims deviate from noninvolved children on all psychological processes alike). Overall, the shared processes model received more support than the distinct processes model. These results suggest that in early childhood, bullies and bully-victims have shared, rather than distinct psychological processes underlying their bullying behavior.
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Agresión/psicología , Acoso Escolar , Víctimas de Crimen/psicología , Grupo Paritario , Percepción Social , Niño , Preescolar , Emociones/fisiología , Femenino , Hostilidad , Humanos , Intención , Masculino , Modelos Psicológicos , Ajuste Social , Teoría de la Mente/fisiologíaRESUMEN
Purpose Inhomogeneity of arterial wall thickness may be indicative of distal plaques. This study investigates the intra-subject association between relative spatial intima-media thickness (IMT) inhomogeneity of the common carotid artery (CCA) and the degree of stenosis of plaques in the internal carotid artery (ICA). Materials and Methods We included 240 patients with a recent ischemic stroke or transient ischemic attack and mild-to-moderate stenosis in the ipsilateral ICA. IMT inhomogeneity was extracted from B-mode ultrasound recordings. The degree of ICA stenosis was assessed on CT angiography according to the European Carotid Surgery Trial method. Patients were divided into groups with a low (≤â2â%) and a high (>â2â%) IMT inhomogeneity scaled with respect to the local end-diastolic diameter. Results 182 patients had suitable CT and ultrasound measurements. Relative CCA-IMT inhomogeneity was similar for the symptomatic and asymptomatic side (difference: 0.02â%, pâ=â0.85). High relative IMT inhomogeneity was associated with a larger IMT (difference: 235âµm, pâ<â0.001) and larger degree of ICA stenosis (difference: 5â%, pâ=â0.023) which remained significant (pâ=â0.016) after adjustment for common risk factors. Conclusion Regardless of common risk factors, high relative CCA-IMT inhomogeneity is associated with a greater degree of ICA stenosis and is therefore indicative of atherosclerotic disease. The predictive value of CCA-IMT inhomogeneity for plaque progression and recurrence of cerebrovascular symptoms will be determined in the follow-up phase of PARISK.
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Arteria Carótida Interna , Grosor Intima-Media Carotídeo , Estenosis Carotídea , Arteria Carótida Común , Arteria Carótida Interna/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Constricción Patológica , Humanos , Factores de Riesgo , Túnica MediaRESUMEN
The aim of this study was to introduce and evaluate a contour segmentation method to extract the interfaces of the intima-media complex in carotid B-mode ultrasound images. The method was applied to assess the temporal variation of intima-media thickness during the cardiac cycle. The main methodological contribution of the proposed approach is the introduction of an augmented dimension to process 2-D images in a 3-D space. The third dimension, which is added to the two spatial dimensions of the image, corresponds to the tentative local thickness of the intima-media complex. The method is based on a dynamic programming scheme that runs in a 3-D space generated with a shape-adapted filter bank. The optimal solution corresponds to a single medial axis representation that fully describes the two anatomical interfaces of the arterial wall. The method is fully automatic and does not require any input from the user. The method was trained on 60 subjects and validated on 184 other subjects from six different cohorts and four different medical centers. The arterial wall was successfully segmented in all analyzed images (average pixel size = 57 ± 20 mm), with average segmentation errors of 47 ± 70 mm for the lumen-intima interface, 55 ± 68 mm for the media-adventitia interface and 66 ± 90 mm for the intima-media thickness. The amplitude of the temporal variations in IMT during the cardiac cycle was significantly higher in the diseased population than in healthy volunteers (106 ± 48 vs. 86 ± 34 mm, p = 0.001). The introduced framework is a promising approach to investigate an emerging functional parameter of the arterial wall by assessing the cyclic compression-decompression pattern of the tissues.
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Arterias Carótidas/diagnóstico por imagen , Grosor Intima-Media Carotídeo , Procesamiento de Imagen Asistido por Computador/métodos , Reconocimiento de Normas Patrones Automatizadas/métodos , Arterias Carótidas/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: Intracranial carotid artery calcification (ICAC) is one of the most important risk factors for stroke. Although several environmental risk factors for ICAC have been identified, its genetic background remains unclear. METHODS: Between 2003 and 2006, 2034 participants from the prospective population-based Rotterdam study (mean age: 69.6±6.8 years; 51.7% female) underwent computed tomography to quantify vascular calcification in the intracranial internal carotid artery. Blood samples were drawn for genotyping. Genotypes of the participants were imputed to the 1000 Genomes reference panel to generate genetic relationship matrices for the estimation of the heritability of ICAC volume. Adjustments were made for age and sex. Subsequently, genome-wide association analyses were performed to identify specific variants. RESULTS: The age- and sex-adjusted heritability (h(2)) of ICAC was 47% [standard error (SE): 19%; P=0.009]. Genome-wide association analyses identified a variant on chromosome 9p21.3 (rs1537372; N=2034; P=4.75×10(-9)) and 1 variant on chromosome 11p11.2 (rs11038042, N=2034; P=3.27×10(-8)) that were significantly associated with ICAC volume. Rs1537372 replicated in an independent sample of 716 stroke patients (Pcombined=1.38×10(-10)). CONCLUSIONS: ICAC volume is a heritable trait, which is partly explained by common genetic variation. We identified specific genetic variants associated with ICAC, which given the importance of ICAC in stroke risk, needs replication in larger-scale studies to further elucidate its genetic basis.
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Enfermedades de las Arterias Carótidas/genética , Arteria Carótida Interna/diagnóstico por imagen , Predisposición Genética a la Enfermedad , Accidente Cerebrovascular/etiología , Calcificación Vascular/genética , Anciano , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Femenino , Estudio de Asociación del Genoma Completo , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/genética , Calcificación Vascular/complicaciones , Calcificación Vascular/diagnóstico por imagenRESUMEN
BACKGROUND AND PURPOSE: Intraplaque hemorrhage (IPH), visualized by magnetic resonance imaging, has shown to be associated with the risk of stroke in patients with carotid artery stenosis. The mechanisms of IPH development are poorly understood. In this study, we investigated the association between clinical patient characteristics and carotid IPH on high-resolution magnetic resonance imaging. METHODS: Patients participate in the Plaque at Risk (PARISK) study. This prospective, multicenter cohort study included patients with recent amaurosis fugax, hemispheric transient ischemic attack, or nondisabling stroke in the internal carotid artery territory and an ipsilateral carotid stenosis of <70%, who were not scheduled for carotid revascularization procedure. One hundred patients, recruited between 2010 and 2012, underwent a 3-T high-resolution carotid magnetic resonance imaging. We documented clinical patient characteristics and performed multivariable logistic regression analysis to investigate their association with IPH. RESULTS: IPH was observed in 45 patients (45%) in 1 or both carotid arteries. Male sex and the use of antiplatelet agents before the index event were associated with IPH in univariable analysis. In a multivariable analysis, only previous use of antiplatelet agents was significantly associated with IPH (odds ratio, 2.71; 95% confidence interval, 1.12-6.61). Risk factors of atherosclerotic arterial disease, including a history of symptomatic arterial diseases, were not associated with IPH. CONCLUSIONS: In this cohort of 100 patients with recently symptomatic carotid stenosis, the previous use of antiplatelet agents is associated with carotid IPH on magnetic resonance imaging. Antiplatelet therapy may increase the risk of IPH, but our findings need to be confirmed in larger patient cohorts. The implications for risk stratification remain to be determined.