Plaque density on CT, a potential marker of ischemic stroke

Abstract

The authors sought to determine in a retrospective analysis whether carotid plaque soft TD on CT is associated with recent ischemic neurologic events. Among 141 patients (99 asymptomatic), 106 plaques with more than 50% stenosis were selected for density measurements. They found an odds ratio for neurologic events associated with a 10-point decrease in density of 1.54 (p = 0.002), showing an association between plaque density and neurologic events.

Carotid Artery Plaque Characterization Using CT Multienergy Imaging

“…4 The value of such a distinction is that fatty plaques are more frequently associated with the development of ischemic strokes. 2,6 Therefore, identifying those attenuation values that reliably define a plaque as fatty has clinical relevance.…”

“…1 Prior investigations have demonstrated that CT values of attenuation of the carotid artery plaque, measured in HU, may be a reliable indicator of the socalled "vulnerable plaque," which increases the risk of ischemic stroke. 2,3 The attenuation of the carotid artery plaque varies according to the histologic composition of the plaque, with lipid core and intraplaque hemorrhage associated with low HU values and calcified elements associated with high HU values. 4,5 In CT clinical use, there are thresholds in attenuation that distinguish plaques as fatty, mixed, or calcified; and according to the inclusion of a plaque in a specific category, there is a different risk stratification.…”

Multidetector-Row Computed Tomography in Evaluation of Atherosclerotic Carotid Plaques Complicated with Intraplaque Hemorrhage

“…Several studies showed higher incidence of neurological incidents in patients with socalled soft plaques (plaques predominantly consisting of lipids, tissue debris and hemorrhage). [5][6][7][8][9][10] Ultrasound analysis of carotid plaques demonstrated that hypoechoic plaques represent an independent risk factor for stroke incidence in adults aged 65 years or older. 11 Takaya et al followed asymptomatic patients for 38 months and showed that patients with intraplaque hemorrhage on initial MRI had 5.2 times higher incidence of cerebrovascular events.…”

“…Atherosclerotic carotid plaques with lower tissue density on multidetector-row CT (MDCT) are associated with lower incidence of cerebrovascular events. 6,7 While single slice computed tomography showed conflicting results in determining carotid plaque composition, MDCT showed good correlation of findings with histological analysis of coronary plaques. [23][24][25][26][27] Histological analysis of coronary plaques showed that remodeling of atherosclerotic plaque changes its histological content.…”

Assessment of Carotid Plaque Stability Based on the Dynamic Enhancement Pattern in Plaque Components With Multidetector CT Angiography

“…However, the use of MDCTA on plaque vulnerability is controversial 8 -11,15,20,26,27 with some reports showing the limitation of evaluating Hounsfield units (HU) for the assessment of carotid plaques owing to the blooming effect of calcification and overlapping between plaque components. 15,16,26,27 Recently, some reports have indicated that a dynamic study with contrast-enhanced MRI can differentiate plaque components such as fibrous tissue with a peak in a delayed venous phase and neovascularization with a peak in an early arterial phase. 24,25,28 -30 This concept is based on the difference in absorption of contrast media in each plaque component and therefore it also could be applied to MDCTA, which has not been performed yet.…”