Current Cardiovascular Imaging Reports

, Volume 4, Issue 1, pp 77–84 | Cite as

Molecular MRI of Thrombosis

Article

Abstract

This review focuses on recent approaches in using targeted MRI probes for noninvasive molecular imaging of thrombosis. Probe design strategies are discussed: choice of molecular target; nanoparticle versus small-molecule probe; and gadolinium versus iron oxide imaging reporter. Examples of these different design strategies are chosen from the recent literature. Novel contrast agents used to image direct and indirect binding to fibrin have been described as well as direct binding to activated platelets. Emphasis is placed on probes where utility has been demonstrated in animal models or in human clinical trials.

Keywords

Thrombus MRI Molecular imaging Fibrin Factor XIII Activated platelets Gadolinium Iron oxide 

Notes

Acknowledgment

This work was supported by funding from the National Institutes of Health (EB009062 to P.C.). K.L.C. was supported by a T32 Ruth L. Kirschstein National Research Service Award (5T32CA009502).

Disclosure

K. L. Ciesienski: none; P. Caravan: holds stock in Catalyst Medical LLC.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    White, R. H.: The epidemiology of venous thromboembolism. Circulation 2003, 107:I4–I8.CrossRefPubMedGoogle Scholar
  2. 2.
    Guercini, F., M. Acciarresi, G. Agnelli, et al.: Cryptogenic stroke: Time to determine aetiology. J Thromb Haemost 2008, 6:549–554.CrossRefPubMedGoogle Scholar
  3. 3.
    Di Tullio, M. R., C. Russo, Z. Jin, et al.: Aortic arch plaques and risk of recurrent stroke and death. Circulation 2009, 119:2376–2382.CrossRefPubMedGoogle Scholar
  4. 4.
    Mazighi, M., J. Labreuche, F. Gongora-Rivera, et al.: Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke. Stroke 2008, 39:1142–1147.CrossRefPubMedGoogle Scholar
  5. 5.
    Mazighi, M., J. Labreuche, F. Gongora-Rivera, et al.: Autopsy prevalence of proximal extracranial atherosclerosis in patients with fatal stroke. Stroke 2009, 40:713–718.CrossRefPubMedGoogle Scholar
  6. 6.
    Overell, J. R., I. Bone and K. R. Lees: Interatrial septal abnormalities and stroke: A meta-analysis of case-control studies. Neurology 2000, 55:1172–1179.PubMedGoogle Scholar
  7. 7.
    Amarenco, P., C. Duyckaerts, C. Tzourio, et al.: The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med 1992, 326:221–225.CrossRefPubMedGoogle Scholar
  8. 8.
    Amarenco, P., A. Cohen, C. Tzourio, et al.: Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 1994, 331:1474–1479.CrossRefPubMedGoogle Scholar
  9. 9.
    Tunick, P. A., B. P. Rosenzweig, E. S. Katz, et al.: High risk for vascular events in patients with protruding aortic atheromas: A prospective study. J Am Coll Cardiol 1994, 23:1085–1090.CrossRefPubMedGoogle Scholar
  10. 10.
    Jones, E. F., J. M. Kalman, P. Calafiore, et al.: Proximal aortic atheroma. An independent risk factor for cerebral ischemia. Stroke 1995, 26:218–224.PubMedGoogle Scholar
  11. 11.
    Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. The french study of aortic plaques in stroke group. N Engl J Med 1996, 334:1216–1221.Google Scholar
  12. 12.
    Di Tullio, M. R., R. L. Sacco, D. Gersony, et al.: Aortic atheromas and acute ischemic stroke: A transesophageal echocardiographic study in an ethnically mixed population. Neurology 1996, 46:1560–1566.PubMedGoogle Scholar
  13. 13.
    Mitusch, R., C. Doherty, H. Wucherpfennig, et al.: Vascular events during follow-up in patients with aortic arch atherosclerosis. Stroke 1997, 28:36–39.PubMedGoogle Scholar
  14. 14.
    Fujimoto, S., M. Yasaka, R. Otsubo, et al.: Aortic arch atherosclerotic lesions and the recurrence of ischemic stroke. Stroke 2004, 35:1426–1429.CrossRefPubMedGoogle Scholar
  15. 15.
    Tanaka, M., M. Yasaka, K. Nagano, et al.: Moderate atheroma of the aortic arch and the risk of stroke. Cerebrovasc Dis 2006, 21:26–31.CrossRefPubMedGoogle Scholar
  16. 16.
    Meissner, I., B. K. Khandheria, S. G. Sheps, et al.: Atherosclerosis of the aorta: Risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study. J Am Coll Cardiol 2004, 44:1018–1024.CrossRefPubMedGoogle Scholar
  17. 17.
    Russo, C., Z. Jin, T. Rundek, et al.: Atherosclerotic disease of the proximal aorta and the risk of vascular events in a population-based cohort: The aortic plaques and risk of ischemic stroke (apris) study. Stroke 2009, 40:2313–2318.CrossRefPubMedGoogle Scholar
  18. 18.
    Bosnjakovic, V. B., B. D. Jankovic, J. Horvat, et al.: Radiolabeled anti-human fibrin antibody: A new thrombus-detecting agent. Lancet 1977, 8009:452–454.CrossRefGoogle Scholar
  19. 19.
    Harwig, S. S. L., J. F. Harwig and M. J. Welch: Preparation of technetium-99m-labeled fibrinogen. J. Nucl. Med. 1976, 17:151–152.PubMedGoogle Scholar
  20. 20.
    Balu, N., J. Wang, L. Dong, et al.: Current techniques for MR imaging of atherosclerosis. Top Magn Reson Imaging 2009, 20:203–215.CrossRefPubMedGoogle Scholar
  21. 21.
    Underhill, H. R., T. S. Hatsukami, Z. A. Fayad, et al.: MRI of carotid atherosclerosis: Clinical implications and future directions. Nat Rev Cardiol 2010, 7:165–173.CrossRefPubMedGoogle Scholar
  22. 22.
    Wang, J., N. Balu, G. Canton, et al.: Imaging biomarkers of cardiovascular disease. J Magn Reson Imaging 2010, 32:502–515.CrossRefPubMedGoogle Scholar
  23. 23.
    Marder, V. J., D. J. Chute, S. Starkman, et al.: Analysis of thrombi retrieved from cerebral arteries of patients with acute ischemic stroke. Stroke 2006, 37:2086–2093.CrossRefPubMedGoogle Scholar
  24. 24.
    Spuentrup, E., B. Fausten, S. Kinzel, et al.: Molecular magnetic resonance imaging of atrial clots in a swine model. Circulation 2005, 112:396–399.CrossRefPubMedGoogle Scholar
  25. 25.
    Spuentrup, E., M. Katoh, A. Buecker, et al.: Molecular MR imaging of human thrombi in a swine model of pulmonary embolism using a fibrin-specific contrast agent. Invest Radiol 2007, 42:586–595.CrossRefPubMedGoogle Scholar
  26. 26.
    Botnar, R. M., A. S. Perez, S. Witte, et al.: In vivo molecular imaging of acute and subacute thrombosis using a fibrin-binding magnetic resonance imaging contrast agent. Circulation 2004, 109:2023–2029.CrossRefPubMedGoogle Scholar
  27. 27.
    Overoye-Chan, K., S. Koerner, R. J. Looby, et al.: EP-2104R: A fibrin-specific gadolinium-based MRI contrast agent for detection of thrombus. J Am Chem Soc 2008, 130:6025–6039.CrossRefPubMedGoogle Scholar
  28. 28.
    Botnar, R. M., A. Buecker, A. J. Wiethoff, et al.: In vivo magnetic resonance imaging of coronary thrombosis using a fibrin-binding molecular magnetic resonance contrast agent. Circulation 2004, 110:1463–1466.CrossRefPubMedGoogle Scholar
  29. 29.
    Spuentrup, E., M. Katoh, A. J. Wiethoff, et al.: Molecular magnetic resonance imaging of pulmonary emboli with a fibrin-specific contrast agent. Am J Respir Crit Care Med 2005, 172:494–500.CrossRefPubMedGoogle Scholar
  30. 30.
    Stracke, C. P., M. Katoh, A. J. Wiethoff, et al.: Molecular MRI of cerebral venous sinus thrombosis using a new fibrin-specific MR contrast agent. Stroke 2007, 38:1476–1481.CrossRefPubMedGoogle Scholar
  31. 31.
    Katoh, M., P. Haage, A. J. Wiethoff, et al.: Molecular magnetic resonance imaging of deep vein thrombosis using a fibrin-targeted contrast agent: A feasibility study. Invest Radiol 2009, 44:146–150.CrossRefPubMedGoogle Scholar
  32. 32.
    Spuentrup, E., A. Buecker, M. Katoh, et al.: Molecular magnetic resonance imaging of coronary thrombosis and pulmonary emboli with a novel fibrin-targeted contrast agent. Circulation 2005, 111:1377–1382.CrossRefPubMedGoogle Scholar
  33. 33.
    Sirol, M., V. Fuster, J. J. Badimon, et al.: Chronic thrombus detection with in vivo magnetic resonance imaging and a fibrin-targeted contrast agent. Circulation 2005, 112:1594–1600.CrossRefPubMedGoogle Scholar
  34. 34.••
    Vymazal, J., E. Spuentrup, G. Cardenas-Molina, et al.: Thrombus imaging with fibrin-specific gadolinium-based MR contrast agent EP-2104R: Results of a phase II clinical study of feasibility. Invest Radiol 2009, 44:697–704. This paper describes the results of a 52-patient phase 2 feasibility study. Patients with known thrombus in one of six vascular territories were imaged pre and post contrast agent. EP-2104R–enhanced MRI detected both thrombi not readily visible precontrast screening and gave additional enhancement of thrombi that are visible in precontrast imaging.CrossRefPubMedGoogle Scholar
  35. 35.••
    Spuentrup, E., R. M. Botnar, A. J. Wiethoff, et al.: MR imaging of thrombi using EP-2104R, a fibrin-specific contrast agent: Initial results in patients. Eur Radiol 2008, 18:1995–2005. First examples of molecular MRI of thrombus in patients. Bright spot imaging with the fibrin-targeted gadolinium probe EP-2104R.CrossRefPubMedGoogle Scholar
  36. 36.•
    Uppal, R., I. Ay, G. P. Dai, et al.: Molecular MRI of intracranial thrombus in a rat ischemic stroke model. Stroke 2010, 41:1271–1277. This paper shows that EP-2104R–enhanced MRI can successfully identify intracranial thrombus in a rat embolic stroke model. It demonstrates efficacy of this probe at high fields and in small animal models. Fresh as well as aged thrombi are visualized.CrossRefPubMedGoogle Scholar
  37. 37.
    Flacke, S., S. Fischer, M. J. Scott, et al.: Novel MRI contrast agent for molecular imaging of fibrin: Implications for detecting vulnerable plaques. Circulation 2001, 104:1280–1285.CrossRefPubMedGoogle Scholar
  38. 38.
    Winter, P. M., S. D. Caruthers, X. Yu, et al.: Improved molecular imaging contrast agent for detection of human thrombus. Magn Reson Med 2003, 50:411–416.CrossRefPubMedGoogle Scholar
  39. 39.
    Pan, D., S. D. Caruthers, G. Hu, et al.: Ligand-directed nanobialys as theranostic agent for drug delivery and manganese-based magnetic resonance imaging of vascular targets. J Am Chem Soc 2008, 130:9186–9187.CrossRefPubMedGoogle Scholar
  40. 40.
    Pan, D. P. J., A. Senpan, S. D. Caruthers, et al.: Sensitive and efficient detection of thrombus with fibrin-specific manganese nanocolloids. Chem Commun 2009, 3234–3236.Google Scholar
  41. 41.•
    Miserus, R.-J. J. H. M., M. V. Herias, L. Prinzen, et al.: Molecular MRI of early thrombus formation using a bimodal alpha2-antiplasmin-based contrast agent. JACC Cardiovasc Imaging 2009, 2:987–996. This is an example of using factor XIII as a signal amplification strategy. Gadolinium-based probes using an α 2 -antiplasmin motif are covalently attached to fibrin in vivo by the action of factor XIII. Two-photon microscopy of the bimodal contrast agent confirmed mechanism of action. This probe was effective at imaging early, but not late or organized thrombus.CrossRefPubMedGoogle Scholar
  42. 42.•
    McCarthy, J. R., P. Patel, I. Botnaru, et al.: Multimodal nanoagents for the detection of intravascular thrombi. Bioconj Chem 2009, 20:1251–1255. This paper discusses fluorescently labeled magnetic nanoparticles targeted to fibrin and activated factor XIII. Both nanoagents possess high affinities for thrombi in vivo, and enable multimodal fluorescence and MRI.CrossRefGoogle Scholar
  43. 43.
    Klink, A., E. Lancelot, S. Ballet, et al.: Magnetic resonance molecular imaging of thrombosis in an arachidonic acid mouse model using an activated platelet targeted probe. Arterioscler Thromb Vasc Biol. 2010, 30:403–410.CrossRefPubMedGoogle Scholar
  44. 44.••
    von zur Muhlen, C., D. von Elverfeldt, J. A. Moeller, et al.: Magnetic resonance imaging contrast agent targeted toward activated platelets allows in vivo detection of thrombosis and monitoring of thrombolysis. Circulation 2008, 118:258–267. This is an antibody–iron oxide approach to imaging activated platelets. Binding to activated platelets was demonstrated ex vivo to the surface of symptomatic human carotid plaques and in mouse models of thrombosis and thrombolysis.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Athinoula A. Martinos Center for Biomedical Imaging, Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolCharlestownUSA

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