Abstract
Identification of carotid artery atherosclerosis is conventionally based on measurements of luminal stenosis and surface irregularities using in vivo imaging techniques including sonography, CT and MR angiography, and digital subtraction angiography. However, histopathologic studies demonstrate considerable differences between plaques with identical degrees of stenosis and indicate that certain plaque features are associated with increased risk for ischemic events. The ability to look beyond the lumen using highly developed vessel wall imaging methods to identify plaque vulnerable to disruption has prompted an active debate as to whether a paradigm shift is needed to move away from relying on measurements of luminal stenosis for gauging the risk of ischemic injury. Further evaluation in randomized clinical trials will help to better define the exact role of plaque imaging in clinical decision-making. However, current carotid vessel wall imaging techniques can be informative. The goal of this article is to present the perspective of the ASNR Vessel Wall Imaging Study Group as it relates to the current status of arterial wall imaging in carotid artery disease.
Highlights
Results from recently published meta-analyses support the hypothesis that MR imaging detection of carotid intraplaque hemorrhage (IPH) is associated with increased risk for future primary and recurrent ischemic neurologic events.[79,212,213] the absence of IPH portends a benign clinical course, even among patients with symptomatic 50%–99% carotid stenosis.[213]
Summary Concepts It is clear that there are several plaque features of increased clinical risk supported by associations with endarterectomy specimen analyses
There are several prospective trials intended to examine the value of prospective plaque imaging
Summary
Results from recently published meta-analyses support the hypothesis that MR imaging detection of carotid IPH is associated with increased risk for future primary and recurrent ischemic neurologic events.[79,212,213] the absence of IPH portends a benign clinical course, even among patients with symptomatic 50%–99% carotid stenosis.[213]. 1) To provide general guidelines for carotid MR vessel wall imaging with recommended imaging sequences, spatial resolution, and coverage. Essential Features for Identification with Carotid Plaque Imaging. No meta-analyses or prospective trials have suggested that some specific CT features are associated with an increased risk for future primary and recurrent ischemic neurologic events, even if there are several prospective trials on their way or that have been published that examine the value of plaque imaging prospectively (PARISK, CAPIAS, CARE-II).[104,105,106] crosssectional studies have found that some CT characteristics (Hounsfield unit attenuation, the presence of neovascularization) are associated with increased risk of cerebrovascular events.[48,225]. 1) To provide general guidelines for carotid CT vessel wall imaging with recommended desirable imaging techniques, tissue contrast, spatial resolution, and coverage. From aortic col for plaque imaging should be able to
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