CT and MR Imaging of Carotid Wall and Plaque

Abstract

Imaging of the carotid artery wall is the focus of several ongoing research studies that are investigating the optimal approach to identify so-called "vulnerable plaques". Even when standard arterial luminal imaging fails to indicate a stenosis in stroke patients, a non-stenotic plaque may be responsible for the stroke. Indeed, over the past decade there has been a paradigm shift in the diagnosis and risk stratification of patients with carotid artery disease, whereby nowadays more emphasis is put on plaque characterization, mainly by using computed tomography (CT) and magnetic resonance (MR), in addition to the usual assessment of stenosis and surface irregularities. In this review, we will discuss current state-of-the-art CT and MR techniques to characterize vulnerable plaques and summarize current developments in imaging-based assessment of carotid plaques, in order to identify ideal candidates for revascularization and to monitor the effects of medical therapy. JNN 116 http://www.j-nn.org J Neurosonol Neuroimag 2019;11(2):115-125 Luca Saba, et al. Imaging of Carotid Plaque ification and therapy selection in patients with both high-and low-degree carotid artery stenosis.and size of the lipid-rich-necrotic-core (LRNC), and active plaque inflammation. In the following sections the features linked to plaque vulnerability are presented. FIG. 4. Male patient with right hand weakness with ulceration in the (A) left internal carotid artery internal carotid artery visibile in the sagittal, (B) axial and (C) Coronal planes (white arrows).

Review of imaging biomarkers for the vulnerable carotid plaque

“…The maximum thickness of the carotid artery plaque is a simple linear measurement of the maximum plaque thickness and is thought to be associated with other imaging features of plaque vulnerability. 106 The maximum plaque thickness seems to increase the risk of stroke, beyond the degree of stenosis. The plaque volume could be a better parameter in stroke risk assessment than thickness but is more difficult to visualize and quantify than maximum thickness, especially with US.…”