Neuroimaging clinics of North America
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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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Neuroimaging Clin. N. Am. · Feb 2016
ReviewThe Use of Contrast-enhanced Ultrasonography for Imaging of Carotid Atherosclerotic Plaques: Current Evidence, Future Directions.
Contrast-enhanced ultrasonography (CEUS) is a rapidly evolving modality for imaging carotid artery disease and systemic atherosclerosis. CEUS coupled with diagnostic ultrasonography predicts the degree of carotid artery stenosis and is comparable with computed tomography and magnetic resonance angiography. This article reviews the literature on the evolving role of CEUS for the identification and characterization of carotid plaques with an emphasis on detection of intra-plaque neovascularization and related high-risk morphologic features notably present in symptomatic patients. CEUS carotid imaging may play a prominent additive role in risk stratifying patients and serve as a powerful tool for monitoring therapeutic interventions.
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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 Imaging to Decide on Optimal Treatment: Medical Versus Carotid Endarterectomy Versus Carotid Artery Stenting.
Many of the current guidelines for the management of carotid atherosclerosis are based on clinical trial findings published more than 2 decades ago. The lack of plaque information in clinical decision making represents a major shortcoming and highlights the need for contemporary trials based on characteristics of the atherosclerotic lesion itself, rather than luminal stenosis alone. This article summarizes the major dilemmas clinicians face in current practice, and discusses the rationale and evidence that plaque imaging may help to address these challenges and optimize the clinical management of carotid artery disease in the future.