CT Angiographic Features of Symptom-Producing Plaque in Moderate-Grade Carotid Artery Stenosis

Abstract

BACKGROUND AND PURPOSE:Emerging evidence indicates that plaque imaging can improve stroke risk stratification in patients with carotid artery atherosclerosis. We studied the association between soft and hard (calcified) plaque thickness measurements on CTA and symptomatic disease status (ipsilateral stroke or TIA) in patients with moderate-grade carotid artery stenosis.

Prediction of Carotid Intraplaque Hemorrhage Using Adventitial Calcification and Plaque Thickness on CTA

“…This finding corresponds with prior research demonstrating a high ROC AUC by using soft-plaque thickness to predict high plaque signal on 3D TOF, though this was only assessed in severe stenosis groups. 10,11 Further research has demonstrated that soft-plaque thickness on CTA is highly predictive of carotid IPH on T1WI sequences. 27 One limitation of these prior studies was that TOF and other T1-weighted images have poor sensitivity and specificity compared with the MPRAGE sequence.…”

“…9 Plaque thickness has also recently been associated with high plaque signal on 3D TOF imaging, attributed to IPH. 10,11 Recently, we found that these markers in combination (plaque thickness, millimeter stenosis, and ulceration) allow optimal discrimination of IPH in a model including the clinical factors of age and male sex. 12 Together these factors may provide clues to the pathogenesis of IPH.…”

Improving imaging to optimize screening strategies for carotid artery stenosis

“…Even when relatively simple-to-assess measures of plaque vulnerability such as the predominance of than echorich) plaque are present in patients with ≥50% stenosis, such plaque features are associated with a ~2.5 times increase relative risk of stroke (23). Similarly, more recent studies are revisiting the potential value of extracting plaque risk information from routinely acquired cross-sectional MR angiography and CT angiography studies, which also hold significant promise as potential stroke risk assessment tools once cases of carotid stenosis are actually identified (24)(25)(26)(27)(28). These emerging data suggest that these newer technologies are potentially effective and costeffective stroke risk predictors (29).…”

Moving Beyond Luminal Stenosis: Imaging Strategies for Stroke Prevention in Asymptomatic Carotid Stenosis

“…Similarly, there is significant variability in the sonographic criteria used to define plaque echolucency, and therefore techniques that rely upon a quantitative imaging parameter, such as a normalized gray-scale median, may improve standardization of image assessment [63]. In addition, though to-date CT has to date performed relatively poorly in discriminating between specific tissue types in carotid plaque [53,91,92], recent work [93,94,95,96,97] suggests that plaque with greater volumes of ‘soft' or low-attenuation plaque relative to calcified plaque may represent a relatively simple scheme for identifying those carotid plaques most likely to cause ischemic symptoms. Prospective studies using these CT techniques to predict stroke risk are warranted now.…”