Vessel Wall Imaging of the Intracranial and Cervical Carotid Arteries

Abstract

Vessel wall imaging can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries beyond the simple luminal changes that can be observed with traditional luminal evaluation. Differentiating vulnerable from stable plaques and characterizing atherosclerotic plaques are vital parts of the early diagnosis, prevention, and treatment of stroke and the neurological adverse effects of atherosclerosis. Various techniques for vessel wall imaging have been developed and introduced to differentiate and analyze atherosclerotic plaques in the cervical carotid artery. High-resolution magnetic resonance imaging (HR-MRI) is the most important and popular vessel wall imaging technique for directly evaluating the vascular wall and intracranial artery disease. Intracranial artery atherosclerosis, dissection, moyamoya disease, vasculitis, and reversible cerebral vasoconstriction syndrome can also be diagnosed and differentiated by using HR-MRI. Here, we review the radiologic features of intracranial artery disease and cervical carotid artery atherosclerosis on HR-MRI and various other vessel wall imaging techniques (e.g., ultrasound, computed tomography, magnetic resonance, and positron emission tomography-computed tomography).

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

“…The stroke mechanisms were classified by modifying the TOAST (Trial of Org 10172 in acute stroke treatment) classification: large artery atherosclerosis, small vessel occlusion, cardioembolism and dissections [5, 6]. Large artery atherosclerosis was divided according to the site of significant (>50%) stenosis at the relevant distal or proximal VA. Dissection was diagnosed based on the clinical and imaging findings of MR angiography, CT angiography, high-resolution MR or digital subtraction angiographies [7, 8]. The common LMI manifestations – vertigo/dizziness, nystagmus, headache, facial palsy, dysarthria, dysphagia, sensory changes, ataxia, hoarseness and hiccup were recorded.…”

Progression of Vertebral Artery Dissection: Vessel Wall Enhancement and Aneurysm Dilation

“…3 Vessel wall enhancement can also be seen in such other arterial diseases as atherosclerosis, moyamoya disease and vasculitis. 4 Nevertheless, taking account of the change in geometry and the persistent vessel wall enhancement together, we concluded that the dissection had progressed despite conservative treatment.…”

Using the Region of Interest from Time-of-Flight Magnetic Resonance Angiography to Differentiate Between Intracranial Arterial Dissection and True Atherosclerotic Stenosis

“…Nevertheless, recent studies have indicated that digital subtraction angiography (DSA) [6,7] and high-resolution magnetic resonance imaging (HR-MRI) are useful for evaluating and understanding arterial dissection [8].…”

“…We identified atherosclerosis based on previously reported important components, including atherosclerotic plaques, lipid cores, fibrous components, intraplaque hemorrhage, and calcium [8,12].…”