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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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.
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Measurement of plaque burden is different from measurement of carotid intima-media thickness (IMT). Carotid total plaque area is a stronger predictor of cardiovascular risk than IMT, and in contrast to progression of IMT, which does not predict cardiovascular events, progression of total plaque area and total plaque volume strongly predict cardiovascular events. ⋯ Perhaps more importantly, it can be used for management of patients. A strategy called "treating arteries instead of treating risk factors" markedly reduces risk among patients with asymptomatic carotid stenosis.
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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.