Neuroimaging clinics of North America
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Atherogenesis is an inflammatory process that begins in childhood. Early detection of atherosclerosis might allow for selection of subjects at risk for future cerebrovascular events at a time when dietary and lifestyle modification may have its greatest impact, and medical intervention may be useful for those who are refractory to such treatment or who are at greater risk for an event. Early detection relies on a knowledge of the distribution of atheroma formation, which can be predicted by understanding the hemodynamic patterns of blood flow. ⋯ In these individuals, understanding atheroma morphology may prove to be of greater utility for assessing stroke risk and determining the appropriate management. Morphologic characterization may also be helpful in monitoring the effect of medical intervention. MRI has proven capable of characterizing the morphologic composition of carotid atheroma, although the clinical implications continue to be investigated.
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High spatial resolution magnetic resonance imaging (MRI) is one of the most promising modalities for visualizing the carotid atherosclerotic plaque. MR allows direct visualization of the diseased vessel wall, is capable of characterizing plaque morphology, and can potentially monitor progression of the disease. ⋯ Improved imaging techniques are therefore needed to reliably identify the high-risk plaques that lead to cerebrovascular events. This article focuses on the current state-of-the-art in MR carotid atherosclerotic plaque imaging to evaluate plaque morphology and composition.
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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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Much has been learned about microembolization in the last two decades. The promising blood markers for brain injury will further enhance our future understanding of microembolic events. New surgical techniques, drugs, and devices have substantially reduced microembolization during carotid angioplasty, CEA, and CABG.
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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.