Non-invasive Carotid Artery Imaging to Identify the Vulnerable Plaque: Current Status and Future Goals

Abstract

MRI has demonstrated the most potential, with good sensitivity and specificity for most plaque characteristics. However, currently there is no single imaging modality that can reliably identify the vulnerable plaque in relation to development of future stroke.

An evaluation of dual source computed tomography used with the de Weert classification to detect vulnerable plaque, using IVUS virtual histology as a standard of reference

“…17,18 Therefore, the morphological features of atherosclerotic plaque have been suggested as a complement to luminal narrowing measurements in stroke risk assessment. [9][10][11]19 Several studies have demonstrated that the presence of a specific vulnerable plaque type (with a large lipid core and a thin fibrous cap) can be used as an independent risk predictor of ischemic cerebrovascular events. 7,8 The clinical consequences of plaque ulceration have been clearly demonstrated in several studies, including NAS-CET.…”

“…7,8 Therefore, it seems that in the coming years diagnostic algorithms should be augmented with assessments of atherosclerotic plaque morphology. [9][10][11] In 2009, in a study published in Stroke, de Weert et al proposed an interesting method for indirect assessment of plaque morphology using minimally invasive multidetector computed tomography angiography (MDCTA) and their own classification system. 12 The authors correlated the MDCTA results with clinical data regarding the severity of stenosis, cardiovascular risk factors and symptomatology.…”

Cap inflammation leads to higher plaque cap strain and lower cap stress: An MRI-PET/CT-based FSI modeling approach

“…Considerable progress has been made in recent years in medical imaging (Tarkin et al, 2016; Vesey et al, 2016; Underhill et al, 2010; Huibers et al, 2015) and image-based computational modeling (Bluestein et al, 2008; Friedman et al, 2010; Samady et al, 2011; Tang et al, 2004, 2005a, 2005b, 2009, 2014; Stone et al, 2012; Vengrenyuk et al, 2006) for better understanding of plaque progression and rupture. Tang et al (2014) provided a recent review for plaque biomechanical analysis, covering essential topics including plaque components, tissue, modeling, and limitations and challenges the current technologies are facing.…”

“…Fayad et al (2011) and others have been developing multi-modality imaging technology using PET/CT (Positron Emission Tomography/ Computed Tomography) and MRI (magnetic resonance imaging) to identify inflammation in arteries (Tarkin et al, 2016; Vesey et al, 2016; Huibers et al, 2015; Fayad et al, 2011; Calcagno et al, 2013). Combining PET/CT with MRI, we are able to obtain plaque morphology with inflammation information on cap surface.…”

Current status of carotid ultrasound in atherosclerosis

“…Ultrasound lacks sensitivity for the detection of plaque ulceration with wide variation ranging from 33-75% in sensitivity and 33-92% in specificity (70). The conventional criteria defines plaque ulceration as a recess of the plaque surface measuring at least 2 mm deep and 2 mm long, with a well-defined wall at its base and an area of reversed color Doppler flow within the recess (71).…”