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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.

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59-year old patient with a right-sided symptomatic stenosis. The PET CT shows hypercaptation in the right-sided carotid wall. MR shows a thickened carotid wall.
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Figure 6: 59-year old patient with a right-sided symptomatic stenosis. The PET CT shows hypercaptation in the right-sided carotid wall. MR shows a thickened carotid wall.

Mentions: Traditionally, nuclear medicine imaging with PET was used to image mainly cerebral degenerative diseases [18], to study brain activation or for oncologic purposes. The capacity of PET to detect inflammatory lesions is well known and has also been used for vascular purposes with some success [19]. It is mainly 18F-FDG PET that is going to be performed since it does seem to image inflammatory processes associated with an increased macrophagic activity [20]. From a technical point of view, Imaging is done 1 hour after injection of FDG [21, 22]. Also, Positron Emission Tomography has known an explosive development with the arrival of PET-CT scanners: whereas before the method had a somewhat limited application due to its relatively low spatial resolution, the capacity to perform at the same time anatomic and functional imaging was a real revolution; this is why PET-CT scanners have been widely deployed over the last decade. An area where PET imaging has also been used is in the assessment of carotid artery disease where a number of studies have shown its capacity to detect potentially inflammatory processes that underlie the embolic events [23]. A recent study seems to confirm that PET could be an early predictor of stroke recurrence and could thus be of help in selecting patients for early therapy [24]. Various examples of PET-CT images showing significant tracer uptake in the carotid wall are provided in (Figs. 6-10). However, there is still some discussion as to whether the findings will guarantee that the method is superior to high-resolution CT [25]. This is in part due to a high variation in findings between CT, PET and MRI [26].


Neuroimaging of the Vulnerable Plaque
59-year old patient with a right-sided symptomatic stenosis. The PET CT shows hypercaptation in the right-sided carotid wall. MR shows a thickened carotid wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: 59-year old patient with a right-sided symptomatic stenosis. The PET CT shows hypercaptation in the right-sided carotid wall. MR shows a thickened carotid wall.
Mentions: Traditionally, nuclear medicine imaging with PET was used to image mainly cerebral degenerative diseases [18], to study brain activation or for oncologic purposes. The capacity of PET to detect inflammatory lesions is well known and has also been used for vascular purposes with some success [19]. It is mainly 18F-FDG PET that is going to be performed since it does seem to image inflammatory processes associated with an increased macrophagic activity [20]. From a technical point of view, Imaging is done 1 hour after injection of FDG [21, 22]. Also, Positron Emission Tomography has known an explosive development with the arrival of PET-CT scanners: whereas before the method had a somewhat limited application due to its relatively low spatial resolution, the capacity to perform at the same time anatomic and functional imaging was a real revolution; this is why PET-CT scanners have been widely deployed over the last decade. An area where PET imaging has also been used is in the assessment of carotid artery disease where a number of studies have shown its capacity to detect potentially inflammatory processes that underlie the embolic events [23]. A recent study seems to confirm that PET could be an early predictor of stroke recurrence and could thus be of help in selecting patients for early therapy [24]. Various examples of PET-CT images showing significant tracer uptake in the carotid wall are provided in (Figs. 6-10). However, there is still some discussion as to whether the findings will guarantee that the method is superior to high-resolution CT [25]. This is in part due to a high variation in findings between CT, PET and MRI [26].

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