Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2002
ReviewNoncoronary and coronary atherothrombotic plaque imaging and monitoring of therapy by MRI.
In the future, the use of imaging methods to quantify the progression and regression of atherosclerosis could play a strong role in the management of patients. High-resolution, noninvasive MRI may provide exhaustive 3-D anatomic information about the lumen and the vessel wall. ⋯ The high resolution of MRI and the development of sophisticated contrast agents offer the promise of molecular in vivo molecular imaging of the plaque. This may aid early intervention (e.g., lipid lowering drug regiments) in both primary and secondary treatment of vascular disease in all arterial beds.
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Despite some limitations, TEE is a sensitive and specific diagnostic technique for the diagnosis and evaluation of aortic plaque. TEE provides a semi-invasive, portable, and widely available means for assessing aortic plaque and associated embolic risk in patients with embolic events, thus guiding rational therapeutic choices. Improvement in tissue characterization and three-dimensional capabilities may further improve the diagnostic accuracy of TEE for aortic plaque detection and evaluation.
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Neuroimaging Clin. N. Am. · Aug 2002
ReviewDiffusion and perfusion MRI for the assessment of carotid atherosclerosis.
Atherosclerotic disease of the extracranial vessels is a frequent cause of cerebral ischemia and stroke. Many natural history studies and prospective treatment trials with large patient samples have focused on optimal patient assessment in regard to medical or interventional measures. ⋯ Besides MRA improvements, DWI and PWI are increasingly used in addition to conventional MR contrasts (PD, T2-, T1-weighted MRI) in attempts to gather information on tissue status and the pathophysiology of hemodynamic compromise and cerebral ischemia in patients with carotid artery stenosis. Obtaining background information using this array of MR data may eventually become a basis for optimal risk-benefit assessment in patients with carotid artery stenosis.
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Neuroimaging Clin. N. Am. · Aug 2002
ReviewDiagnostic imaging of aortic atherosclerosis and its complications.
Thoracic aortic atherosclerosis has been shown to be an important cause of severe morbidity and mortality. At the present time, the case of performance, detailed information obtainable, and availability make TEE the procedure of choice for the imaging of thoracic aortic atherosclerosis; however, further technical advances in MR and CT, particularly in MR plaque characterization and the use of plaque specific contrast agents, may allow for a less invasive and more complete evaluation of thoracic aortic atherosclerosis in the near future. Gadolinium-enhanced 3DMRA is the procedure of choice for the noninvasive detection of plaque in the proximal aortic arch vessels. Furthermore, both CT and MRI are better suited to evaluate penetrating atherosclerotic ulcers and their complications such as intramural hematoma, pseudoaneurysm formation, and aortic rupture.
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Neuroimaging Clin. N. Am. · Aug 2002
ReviewNoninvasive imaging of atherosclerotic plaque in the arch of the aorta with transcutaneous B-mode ultrasonography.
Atherosclerotic plaque at the arch of the aorta has been identified as a potential source for atheroembolic stroke. Imaging of aortic arch plaque can be performed with transesophageal echocardiography (TEE), but TEE is an invasive procedure. ⋯ Noninvasive imaging of the aortic arch can be employed in diagnosing the etiology of cerebrovascular disease in patients with stroke or transient ischemic attack in conjunction with duplex B-mode sonography of the extracranial carotid arteries. It also provides a noninvasive method for studying atherosclerotic plaque in the aortic arch which is applicable for investigational studies of the mechanisms of atherosclerosis and evaluation of pharmacological agents designed to treat atherosclerotic disease.