MR Imaging of Carotid Plaque Composition During Lipid-Lowering Therapy

Zhao, Xue Qiao; Dong, Li; Hatsukami, Tom; Phan, Binh An P.; Chu, Baocheng; Moore, Alice E.; Lane, Trevor; Neradilek, Moni B.; Polissar, Nayak L.; Monick, Duane; Lee, Colin; Underhill, Hunter R.; Yuan, Chun

doi:10.1016/j.jcmg.2011.06.013

Cited by 148 publications

(93 citation statements)

References 33 publications

(32 reference statements)

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“…93 Another trial used MR plaque imaging to demonstrate that intensive lipid therapy with atorvastatin resulted in significant reductions in the carotid plaque LRNC volume. 128 Serial MRI studies have also demonstrated that high-dose rosuvastatin is associated with marked (60%) reduction in LRNC volume. 112 MR plaque imaging has also been used to identify surgical candidates.…”

Section: Medical and Surgical Therapymentioning

confidence: 98%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

278

172

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abbreviatioNs AHA = American Heart Association; CAS = carotid artery stenting; CEA = carotid endarterectomy; CEUS = contrast-enhanced ultrasonography; CTA = CT angiography; DCE = dynamic contrast-enhanced; DSCT = dual-source CT; FDG = fluorodeoxyglucose; FSE = fast spin echo; Gd = gadolinium; HU = Hounsfield units; IPH = intraplaque hemorrhage; LRNC = lipid-rich necrotic core; MDCT = multidetector-row CT; MDCTA = MDCT angiography; MES = microembolic signal; MMP-9 = matrix metalloproteinase-9; MRA = MR angiography; PDW = proton density-weighted; SUV = standardized uptake value; SUVmax = maximal SUV; TBR = target-to-background ratio; TCD = transcranial Doppler ultrasonography; TIA = transient ischemic attack; TOF = time of flight; USPIO = ultrasmall superparamagnetic iron oxide. Carotid artery stenosis is a well-established risk factor of ischemic stroke, contributing to up to 10%-20% of strokes or transient ischemic attacks. Many clinical trials over the last 20 years have used measurements of carotid artery stenosis as a means to risk stratify patients. However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify patients, not just on the degree of carotid artery stenosis but also on how vulnerable the plaque is to rupture, resulting in ischemic stroke. These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as intraplaque hemorrhage (IPH), plaque ulceration, plaque neovascularity, fibrous cap thickness, and presence of a lipid-rich necrotic core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved patient risk stratification and outcomes. For example, a patient with a low-grade stenosis but an ulcerated plaque may benefit more from a revascularization procedure than a patient with a stable 70% asymptomatic stenosis with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying IPH, ulceration, LRNC, and inflammation. However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH. PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify patients with low- and high-grade carotid artery stenosis....

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Section: Medical and Surgical Therapymentioning

confidence: 98%

Contemporary carotid imaging: from degree of stenosis to plaque vulnerability

Brinjikji¹,

Huston²,

Rabinstein

et al. 2016

JNS

278

172

View full text Add to dashboard Cite

show abstract

“…The lipid depletion theory suggests that plaque stability is improved and cardiovascular events are reduced with medical treatment such as statin therapy to deplete lipids and decrease the LRNC size. 37 Multicontrast MRI of the carotid arteries has been validated with histology and shown to identify and quantify various carotid plaque components including the LRNC, FC, and IPH (Fig. 2).…”

Section: Lipid-rich Necrotic Core With Thin Fcmentioning

confidence: 99%

“…After 3 years of lipid therapy, these 33 subjects had a significant reduction in plaque lipid content. 37 For the first time, an understanding of the time course was provided, with statistically significant plaque lipid depletion observed after 1 year of treatment and continuing into the 2nd year. The LRNC size reduction preceded the plaque regression, consistent with the lipid depletion therapy.…”

mentioning

confidence: 99%

Imaging of high-risk carotid artery plaques: current status and future directions

DeMarco

Huston

2014

FOC

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In this paper, the authors review the definition of high-risk plaque as developed by experienced researchers in atherosclerosis, including pathologists, clinicians, molecular biologists, and imaging scientists. Current concepts of vulnerable plaque are based on histological studies of coronary and carotid artery plaque as well as natural history studies and include the presence of a lipid-rich necrotic core with an overlying thin fibrous cap, plaque inflammation, fissured plaque, and intraplaque hemorrhage. The extension of these histologically identified high-risk carotid plaque features to human in vivo MRI is reviewed as well. The authors also assess the ability of in vivo MRI to depict these vulnerable carotid plaque features. Next, the ability of these MRI-demonstrated high-risk carotid plaque features to predict the risk of ipsilateral carotid thromboembolic events is reviewed and compared with the risk assessment provided by simple carotid artery stenosis measurements. Lastly, future directions of high-risk carotid plaque MRI are discussed, including the potential for increased clinical availability and more automated analysis of carotid plaque MRI. The ultimate goal of high-risk plaque imaging is to design and run future multicenter trials using carotid plaque MRI to guide individual patient selection and decisions about optimal atherosclerotic treatment strategies.

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“…Alternatively, vitamin D may have an effect on the lipid-rich necrotic core where microhemorrhages occur. Most interesting, while statins have been shown to decrease the carotid lipid-rich necrotic core 47 and decrease plaque inflammation, 48 This finding suggests an interaction between statins and vitamin D, and optimizing both may be important in treating patients with carotid IPH. One limitation of our study is its cross-sectional nature, making it difficult to determine causation between low vitamin D levels and carotid IPH.…”

Section: Discussionmentioning

confidence: 99%