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Neuroimaging of the Vulnerable Plaque

View Article: PubMed Central - PubMed

ABSTRACT

Plaque vulnerability due to inflammation has been shown to be a participating factor in the degenerative process in the arterial wall that contributes to stenosis and embolism. This is believed to have an important role to play also in the genesis of stroke or cerebrovascular diseases. In order to appropriately screen patients for treatment, there is an absolute need to directly or indirectly visualize both the normal carotid and the suspected plaque. This can be done with a variety of techniques ranging from ultrasound to computed tomography (CT) and magnetic resonance imaging (MRI). In addition to angiographic techniques, direct imaging of the plaque can be done either by ultrasound or by the so-called molecular imaging techniques, i.e. positron emission tomography (PET). These findings, together with other clinical and paraclinical parameters should finally guide the therapeutic choice.

No MeSH data available.


Related in: MedlinePlus

Dynamic contrast-enhanced MR perfusion (a): Time to peak map compared to Arterial spin labeling MR perfusion (b) in a 82 year old patient with a left sided carotid stenosis.
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Figure 5: Dynamic contrast-enhanced MR perfusion (a): Time to peak map compared to Arterial spin labeling MR perfusion (b) in a 82 year old patient with a left sided carotid stenosis.

Mentions: Magnetic Resonance Imaging, due to its non-radiating nature and its inherent sensitivity to motion and thus flow, should be the natural candidate for imaging of the arteries. While this was in theory true from the beginning, MR imaging of the vessels, even of the major vasculature, was hindered among others by a relatively low resolution and high susceptibility to motion-induces artifacts. With the introduction of contrast-enhanced MR angiography, this has changed since it has subsequently been possible to image the carotids fast with an excellent spatial resolution [13]. This has allowed to non-invasively obtain images of carotid and thus plaque morphology that allow us to explore the disease. A detailed image the carotid wall evaluated by MRI is shown in (Fig. 4). While somewhat overestimating stenosis at times and being susceptible to flow phenomena rendering areas of turbulent flow not visible, MRA still has enormous potential for screening purposes. An example of dynamic contrast-enhanced MR perfusion is provided in (Fig. 5). With the introduction of high-speed imaging, multi-channel coils and higher fields, it is possible to additionally visualize the brain parenchyma that is going to be affected in carotid stenosis [14] by both conventional means as well as by the use of more modern “functional” Neuro-MR techniques such as diffusion-weighted imaging and derived ADC mapping [15].


Neuroimaging of the Vulnerable Plaque
Dynamic contrast-enhanced MR perfusion (a): Time to peak map compared to Arterial spin labeling MR perfusion (b) in a 82 year old patient with a left sided carotid stenosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4997941&req=5

Figure 5: Dynamic contrast-enhanced MR perfusion (a): Time to peak map compared to Arterial spin labeling MR perfusion (b) in a 82 year old patient with a left sided carotid stenosis.
Mentions: Magnetic Resonance Imaging, due to its non-radiating nature and its inherent sensitivity to motion and thus flow, should be the natural candidate for imaging of the arteries. While this was in theory true from the beginning, MR imaging of the vessels, even of the major vasculature, was hindered among others by a relatively low resolution and high susceptibility to motion-induces artifacts. With the introduction of contrast-enhanced MR angiography, this has changed since it has subsequently been possible to image the carotids fast with an excellent spatial resolution [13]. This has allowed to non-invasively obtain images of carotid and thus plaque morphology that allow us to explore the disease. A detailed image the carotid wall evaluated by MRI is shown in (Fig. 4). While somewhat overestimating stenosis at times and being susceptible to flow phenomena rendering areas of turbulent flow not visible, MRA still has enormous potential for screening purposes. An example of dynamic contrast-enhanced MR perfusion is provided in (Fig. 5). With the introduction of high-speed imaging, multi-channel coils and higher fields, it is possible to additionally visualize the brain parenchyma that is going to be affected in carotid stenosis [14] by both conventional means as well as by the use of more modern “functional” Neuro-MR techniques such as diffusion-weighted imaging and derived ADC mapping [15].

View Article: PubMed Central - PubMed

ABSTRACT

Plaque vulnerability due to inflammation has been shown to be a participating factor in the degenerative process in the arterial wall that contributes to stenosis and embolism. This is believed to have an important role to play also in the genesis of stroke or cerebrovascular diseases. In order to appropriately screen patients for treatment, there is an absolute need to directly or indirectly visualize both the normal carotid and the suspected plaque. This can be done with a variety of techniques ranging from ultrasound to computed tomography (CT) and magnetic resonance imaging (MRI). In addition to angiographic techniques, direct imaging of the plaque can be done either by ultrasound or by the so-called molecular imaging techniques, i.e. positron emission tomography (PET). These findings, together with other clinical and paraclinical parameters should finally guide the therapeutic choice.

No MeSH data available.


Related in: MedlinePlus