Neuroimaging clinics of North America
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Plaque imaging by MR imaging provides a wealth of information on the characteristics of individual plaque that may reveal vulnerability to rupture, likelihood of progression, or optimal treatment strategy. T1-weighted and T2-weighted images among other options reveal plaque morphology and composition. ⋯ Numerous approaches for analyzing such images have been developed, validated against histologic gold standards, and used in clinical studies. These efforts are summarized in this article.
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Although treatment guidelines are well established for symptomatic patients with greater than 69% carotid stenosis on catheter angiography, optimal management of lower degrees of stenosis remain unclear. Vessel wall MR imaging of the carotid arteries has proved helpful in the evaluation of plaque burden and vulnerable plaque characteristics, and in stratifying risk in low-grade carotid stenosis. This article discusses the pathophysiology and imaging of atherosclerotic plaques resulting in low-grade carotid stenosis, and the corresponding stroke risk and association with plaque elsewhere in the cardiovascular system.
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Neuroimaging Clin. N. Am. · Feb 2016
ReviewIncorporating Carotid Plaque Imaging into Routine Clinical Carotid Magnetic Resonance Angiography.
The incorporation of a short, easy-to-acquire and simple to read sequence to visualize the vessel wall and detect intraplaque hemorrhage (IPH) is achievable now. Demonstration of IPH may be helpful in primary or secondary prevention of neuroischemic events, assessment prior to carotid intervention and the general definition of an individual's vascular phenotype. The addition of an IPH-detecting vessel wall sequence only adds 5 to 6 minutes to a standard carotid MRI examination making clinical translation feasible and achievable.
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There has been significant progress made in 3-dimensional (3D) carotid plaque MR imaging techniques in recent years. Three-dimensional plaque imaging clearly represents the future in clinical use. With effective flow-suppression techniques, choices of different contrast weighting acquisitions, and time-efficient imaging approaches, 3D plaque imaging offers flexible imaging plane and view angle analysis, large coverage, multivascular beds capability, and even can be used in fast screening.
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Neuroimaging Clin. N. Am. · Feb 2016
ReviewPlaque Assessment in the Management of Patients with Asymptomatic Carotid Stenosis.
The continued occurrence of stroke despite advances in medical therapy for asymptomatic carotid stenosis (ACS) strongly indicates that individual response to medical therapy may vary widely. This article reviews the literature that identifies MR imaging and ultrasound plaque features which are seen in patients at increased risk of future cardiovascular events. Imaging can identify plaque phenotype that is the most amendable to intensive medical therapy. There is also good evidence that plaque imaging can measure the individual response to medical therapy and the lack of response identifies a high-risk group of ACS patients.