Imaging modalities to diagnose carotid artery stenosis: progress and prospect

Abstract

In the past few decades, imaging has been developed to a high level of sophistication. Improvements from one-dimension (1D) to 2D images, and from 2D images to 3D models, have revolutionized the field of imaging. This not only helps in diagnosing various critical and fatal diseases in the early stages but also contributes to making informed clinical decisions on the follow-up treatment profile. Carotid artery stenosis (CAS) may potentially cause debilitating stroke, and its accurate early detection is therefore important. In this paper, the technical development of various CAS diagnosis imaging modalities and its impact on the clinical efficacy is thoroughly reviewed. These imaging modalities include duplex ultrasound (DUS), computed tomography angiography (CTA) and magnetic resonance angiography (MRA). For each of the imaging modalities considered, imaging methodology (principle), critical imaging parameters, and the extent of imaging the vulnerable plaque are discussed. DUS is usually the initial recommended CAS diagnostic examination. However, for the therapeutic intervention, either MRA or CTA is recommended for confirmation, and for added information on intracranial cerebral circulation and aortic arch condition for procedural planning. Over the past few decades, the focus of CAS diagnosis has also shifted from pure stenosis quantification to plaque characterization. This has led to further advancement in the existing imaging tools and development of other potential imaging tools like Optical coherence tomography (OCT), photoacoustic tomography (PAT), and infrared (IR) thermography.

Study on the relationship between Cardio-cerebrovascular events and the level of Atherosclerosis evaluated by Heart-brain Integrated CTA

“…The collected data were processed by ADW4. 6 and its stability for atherosclerosis is much higher than that of arterial lumen stenosis 14 , so we further analyze the composition of plaque. Using the improved APQ non-calcified plaque detection technique, the plaque was divided into calcified plaque, non-calcified plaque and mixed plaque.…”

Study on the relationship between Cardio-cerebrovascular events and the level of Atherosclerosis evaluated by Heart-brain Integrated CTA

“…The degree of stenosis = (1 the lumen area of the lesion site / the lumen area of the control site) x100%. It is found that the risk of plaque composition and its stability for atherosclerosis is much higher than that of arterial lumen stenosis 14 , so we further analyze the composition of plaque. Using the improved APQ non-calcified plaque detection technique, the plaque was divided into calcified plaque, non-calcified plaque and mixed plaque.…”

Gradient of luminal narrowing of internal carotid artery on atherosclerotic plaque as risk factor for cerebral ischemic damage

“…Степень стеноза ВСА, в %, как отношение величины разности истинного просвета и должного на уровне стеноза, к должному (несуженному), рассчитывалась по методике ECST [5,7,8].…”

“…В то же время при своевременном раннем выявлении атеросклеротического стенозирования коррекция его с помощью эндоваскулярных технологий в состоянии вернуть прогноз жизни и трудоспособности как минимум на средне-популяционный уровень [3,4]. Поэтому поиск наиболее диагностически и прогностически значимых характеристик сужения гемодинамического просвета артерий головного мозга сохраняет сегодня свою не только научную, но в первую очередь социально-экономическую актуальность [3,5].…”

“…Современные методы количественной оценки тяжести стенозирующего атеросклероза каротидных и коронарных артерий, как правило, основаны на расчете сложных функциональных индексов, таких, как перфузионный резерв или фракционный резерв кровотока [6,7], гидродинамических кривых "стеноз-поток" [8], или же -наоборот -на простом геометрическом соотношении площадей или диаметров сосуда в месте стеноза и на уровне нормального просвета [5,9], без учета расстояния между ними.…”