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Cardiovascular magnetic resonance in carotid atherosclerotic disease.

Dong L, Kerwin WS, Ferguson MS, Li R, Wang J, Chen H, Canton G, Hatsukami TS, Yuan C - J Cardiovasc Magn Reson (2009)

Bottom Line: Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds.Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death.Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, University of Washington, Seattle, WA, USA. lido2@u.washington.edu

ABSTRACT
Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR) of the carotid vessel wall is one promising modality in the evaluation of patients with carotid atherosclerotic disease. Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis. Although carotid vessel wall CMR has not been widely used to screen for carotid atherosclerotic disease, many trials support its potential for this indication. This review summarizes the current state of knowledge regarding carotid vessel wall CMR and its potential clinical application for management of carotid atherosclerotic disease.

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Related in: MedlinePlus

Atherosclerotic Carotid Artery Lipid-rich Necrotic Core. Multi contrast black and bright blood sequences show a large lipid-rich necrotic core (small arrow) with an intact thick fibrous cap best seen in the post contrast T1 weighted (CE T1W) image (long arrow). Calcification is also visible at the base of the plaque (chevron). Asterisks are placed on the lumen.
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Figure 4: Atherosclerotic Carotid Artery Lipid-rich Necrotic Core. Multi contrast black and bright blood sequences show a large lipid-rich necrotic core (small arrow) with an intact thick fibrous cap best seen in the post contrast T1 weighted (CE T1W) image (long arrow). Calcification is also visible at the base of the plaque (chevron). Asterisks are placed on the lumen.

Mentions: Gadolinium-based contrast agents provided additional information for characterization of the necrotic core and the fibrous cap (Figure 4) [17,18,45]. The addition of contrast agent can increase the signal intensity of fibrous tissue by 79.5% due to the presence of microvasculature; conversely, due to the lack of microvasculature, the necrotic core has the least enhancement 28.6% [17]. The minimal enhancement of the LRNC results in good contrast with fibrous tissue and can be used to determine the boundary of the necrotic core with good accuracy as shown in Figure 4. Wasserman et al. found that gadolinium-enhanced T1W images could delineate the fibrous cap from the LRNC, with a contrast-to-noise ratio similar or better than that of T2W images but with approximately twice the signal-noise-ratio [18]. Takaya et al. also found that in vivo CMR measurement of LRNC size was more reproducible when using contrast agent [46]. Cai et al. took contrast one-step further by comparing the size of the enhanced fibrous cap to corresponding histology (For maximal thickness: r = 0.78, p < 0.001; for length: r = 0.73, p < 0.001; for area: r = 0.73, p < 0.001) [45].


Cardiovascular magnetic resonance in carotid atherosclerotic disease.

Dong L, Kerwin WS, Ferguson MS, Li R, Wang J, Chen H, Canton G, Hatsukami TS, Yuan C - J Cardiovasc Magn Reson (2009)

Atherosclerotic Carotid Artery Lipid-rich Necrotic Core. Multi contrast black and bright blood sequences show a large lipid-rich necrotic core (small arrow) with an intact thick fibrous cap best seen in the post contrast T1 weighted (CE T1W) image (long arrow). Calcification is also visible at the base of the plaque (chevron). Asterisks are placed on the lumen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2806867&req=5

Figure 4: Atherosclerotic Carotid Artery Lipid-rich Necrotic Core. Multi contrast black and bright blood sequences show a large lipid-rich necrotic core (small arrow) with an intact thick fibrous cap best seen in the post contrast T1 weighted (CE T1W) image (long arrow). Calcification is also visible at the base of the plaque (chevron). Asterisks are placed on the lumen.
Mentions: Gadolinium-based contrast agents provided additional information for characterization of the necrotic core and the fibrous cap (Figure 4) [17,18,45]. The addition of contrast agent can increase the signal intensity of fibrous tissue by 79.5% due to the presence of microvasculature; conversely, due to the lack of microvasculature, the necrotic core has the least enhancement 28.6% [17]. The minimal enhancement of the LRNC results in good contrast with fibrous tissue and can be used to determine the boundary of the necrotic core with good accuracy as shown in Figure 4. Wasserman et al. found that gadolinium-enhanced T1W images could delineate the fibrous cap from the LRNC, with a contrast-to-noise ratio similar or better than that of T2W images but with approximately twice the signal-noise-ratio [18]. Takaya et al. also found that in vivo CMR measurement of LRNC size was more reproducible when using contrast agent [46]. Cai et al. took contrast one-step further by comparing the size of the enhanced fibrous cap to corresponding histology (For maximal thickness: r = 0.78, p < 0.001; for length: r = 0.73, p < 0.001; for area: r = 0.73, p < 0.001) [45].

Bottom Line: Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds.Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death.Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiology, University of Washington, Seattle, WA, USA. lido2@u.washington.edu

ABSTRACT
Atherosclerosis is a chronic, progressive, inflammatory disease affecting many vascular beds. Disease progression leads to acute cardiovascular events such as myocardial infarction, stroke and death. The diseased carotid alone is responsible for one third of the 700,000 new or recurrent strokes occurring yearly in the United States. Imaging plays an important role in the management of atherosclerosis, and cardiovascular magnetic resonance (CMR) of the carotid vessel wall is one promising modality in the evaluation of patients with carotid atherosclerotic disease. Advances in carotid vessel wall CMR allow comprehensive assessment of morphology inside the wall, contributing substantial disease-specific information beyond luminal stenosis. Although carotid vessel wall CMR has not been widely used to screen for carotid atherosclerotic disease, many trials support its potential for this indication. This review summarizes the current state of knowledge regarding carotid vessel wall CMR and its potential clinical application for management of carotid atherosclerotic disease.

Show MeSH
Related in: MedlinePlus