Abstract
SUMMARY: 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.
ABBREVIATIONS:
- CE
- contrast-enhanced
- DIR
- double inversion recovery
- FC
- fibrous cap
- IPH
- intraplaque hemorrhage
- IVUS
- intravascular ultrasound
- LRNC
- lipid-rich necrotic core
- MATCH
- multicontrast atherosclerosis characterization
- SNAP
- simultaneous noncontrast angiography and intraplaque hemorrhage
- SPACE
- sampling perfection with application-optimized contrasts using different flip angle evolution
- US
- ultrasound
Footnotes
The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or US Government. The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the authors, Department of Defense, or any component agency.
- © 2018 by American Journal of Neuroradiology