Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Aug 2002
ReviewNoninvasive imaging of atherosclerotic plaque in the arch of the aorta with transcutaneous B-mode ultrasonography.
Atherosclerotic plaque at the arch of the aorta has been identified as a potential source for atheroembolic stroke. Imaging of aortic arch plaque can be performed with transesophageal echocardiography (TEE), but TEE is an invasive procedure. ⋯ Noninvasive imaging of the aortic arch can be employed in diagnosing the etiology of cerebrovascular disease in patients with stroke or transient ischemic attack in conjunction with duplex B-mode sonography of the extracranial carotid arteries. It also provides a noninvasive method for studying atherosclerotic plaque in the aortic arch which is applicable for investigational studies of the mechanisms of atherosclerosis and evaluation of pharmacological agents designed to treat atherosclerotic disease.
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Neuroimaging Clin. N. Am. · Aug 2002
ReviewB-mode ultrasound and spiral CT for the assessment of carotid atherosclerosis.
More studies on the natural history of carotid artery plaques are needed to predict more reliably which plaque types or features are the most dangerous (see Table 2). Studies on carotid and coronary endarterectomy specimens indicate a dynamic process of rupture, thrombus formation, healing, and remodeling of the plaque. A plaque from a symptomatic patient may not show any signs of plaque rupture if the plaque has healed or evolved since the debut of symptoms. ⋯ This progress is most necessary, considering the very high demands for surrogate endpoints and risk markers in clinical intervention studies. Whether ultrasonic plaque characterization can be implemented in broad general clinical practice, for example, in screening of individuals at high risk of developing atherosclerosis and ischemic events, has to be based upon data from large prospective studies with long-term follow-up. IMT is already used in population screening, as in the ARIC study [9,101].
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Neuroimaging Clin. N. Am. · Aug 2002
ReviewNoncoronary and coronary atherothrombotic plaque imaging and monitoring of therapy by MRI.
In the future, the use of imaging methods to quantify the progression and regression of atherosclerosis could play a strong role in the management of patients. High-resolution, noninvasive MRI may provide exhaustive 3-D anatomic information about the lumen and the vessel wall. ⋯ The high resolution of MRI and the development of sophisticated contrast agents offer the promise of molecular in vivo molecular imaging of the plaque. This may aid early intervention (e.g., lipid lowering drug regiments) in both primary and secondary treatment of vascular disease in all arterial beds.
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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.