51
|
Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, Saam T, Moody AR, Li D, Matouk CC, Johnson MH, Jäger HR, Mossa-Basha M, Kooi ME, Fan Z, Saloner D, Wintermark M, Mikulis DJ, Wasserman BA. Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol 2018; 39:E9-E31. [PMID: 29326139 DOI: 10.3174/ajnr.a5488] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
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.
Collapse
Affiliation(s)
- L Saba
- From the Department of Medical Imaging (L.S.), University of Cagliari, Cagliari, Italy
| | - C Yuan
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (C.Y., N.B., M.M.-B.)
| | - Y Qiao
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland
| | - T Saam
- Department of Radiology (T.S.), Ludwig-Maximilian University Hospital, Munich, Germany
| | - A R Moody
- Department of Medical Imaging (A.R.M.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - D Li
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - C C Matouk
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.)
| | - M H Johnson
- Departments of Neurosurgery, Neurovascular and Stroke Programs (C.C.M., M.H.J.).,Radiology and Biomedical Imaging (C.C.M., M.H.J.).,Surgery (M.H.J.), Yale University School of Medicine, New Haven, Connecticut
| | - H R Jäger
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, London, UK
| | | | - M E Kooi
- Department of Radiology (M.E.K.), CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Z Fan
- Biomedical Imaging Research Institute (D.L., Z.F.), Cedars-Sinai Medical Center, Los Angeles, California
| | - D Saloner
- Department of Radiology and Biomedical Imaging (D.S.), University of California, San Francisco, California
| | - M Wintermark
- Department of Radiology (M.W.), Neuroradiology Division, Stanford University, Stanford, California
| | - D J Mikulis
- Division of Neuroradiology (D.J.M.), Department of Medical Imaging, University Health Network
| | - B A Wasserman
- The Russell H. Morgan Department of Radiology and Radiological Sciences (Y.Q., B.A.W.), Johns Hopkins Hospital, Baltimore, Maryland
| | | |
Collapse
|
52
|
|
53
|
Potential of α7 nicotinic acetylcholine receptor PET imaging in atherosclerosis. Methods 2017; 130:90-104. [PMID: 28602809 DOI: 10.1016/j.ymeth.2017.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/02/2017] [Accepted: 06/06/2017] [Indexed: 02/07/2023] Open
Abstract
Atherosclerotic events are usually acute and often strike otherwise asymptomatic patients. Although multiple clinical risk factors have been associated with atherosclerosis, as of yet no further individual prediction can be made as to who will suffer from its consequences based on biomarker analysis or traditional imaging methods like CT, MRI or angiography. Previously, non-invasive imaging with 18F-fluorodeoxyglucose (18F-FDG) PET was shown to potentially fill this niche as it offers high sensitive detection of metabolic processes associated with inflammatory changes in atherosclerotic plaques. However, 18F-FDG PET imaging of arterial vessels suffers from non-specificity and has still to be proven to reliably identify vulnerable plaques, carrying a high risk of rupture. Therefore, it may be regarded only as a secondary marker for monitoring treatment effects and it does not offer alternative treatment options or direct insight in treatment mechanisms. In this review, an overview is given of the current status and the potential of PET imaging of inflammation and angiogenesis in atherosclerosis in general and special emphasis is given to imaging of α7 nicotinic acetylcholine receptors (α7 nAChRs). Due to the gaps that still exist in our understanding of atherogenesis and the limitations of the available PET tracers, the search continues for a more specific radioligand, able to differentiate between stable atherosclerosis and plaques prone to rupture. The potential role of the α7 nAChR as imaging marker for plaque vulnerability is explored. Today, strong evidence exists that nAChRs are involved in the atherosclerotic disease process. They are suggested to mediate the deleterious effects of the major tobacco component, nicotine, a nAChR agonist. Mainly based on in vitro data, α7 nAChR stimulation might increase plaque burden via increased neovascularization. However, in animal studies, α7 nAChR manipulation appears to reduce plaque size due to its inhibitory effects on inflammatory cells. Thus, reliable identification of α7 nAChRs by in vivo imaging is crucial to investigate the exact role of α7 nAChR in atherosclerosis before any therapeutic approach in the human setting can be justified. In this review, we discuss the first experience with α7 nAChR PET tracers and developmental considerations regarding the "optimal" PET tracer to image vascular nAChRs.
Collapse
|
54
|
Cires-Drouet RS, Mozafarian M, Ali A, Sikdar S, Lal BK. Imaging of high-risk carotid plaques: ultrasound. Semin Vasc Surg 2017; 30:44-53. [PMID: 28818258 DOI: 10.1053/j.semvascsurg.2017.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Duplex ultrasonography has a well-established role in the assessment of the degree of stenosis caused by carotid atherosclerosis. This assessment is derived from Doppler velocity changes induced by the narrowing lumen of the artery. New research into the mechanisms for plaque rupture and atheroembolic stroke indicates that the degree of narrowing is an imperfect predictor of stroke risk, and that other factors, such as plaque composition and remodeling and biomechanical forces acting on the plaque, can play a role. New advances in ultrasound imaging technology have made it possible to investigate these measures of plaque vulnerability to identify pre-embolic unstable carotid plaques. Efforts have been made to quantify the morphologic appearance of the plaque in B-mode images and to correlate them with histology. Additional research has resulted in the first generation of clinically available 3-dimensional ultrasound transducers that reduce operator-dependence and variability. Finally, ultrasonography provides real-time imaging and physiologic information that can be utilized to measure disruptive forces acting on carotid plaques. We review some of these exciting developments in ultrasonography and discuss how these may impact clinical practice.
Collapse
Affiliation(s)
- Rafael S Cires-Drouet
- Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201
| | - Mahvash Mozafarian
- Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201
| | - Amir Ali
- Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201; Department of Bioengineering, George Mason University, Fairfax, VA
| | | | - Brajesh K Lal
- Center for Vascular Diagnostics, Division of Vascular Surgery, University of Maryland School of Medicine, 22 South Greene Street, S10-B00, Baltimore, MD 21201; Vascular Service, Veterans Affairs Medical Center, Baltimore, MD.
| |
Collapse
|
55
|
Intravascular endoscopy improvement through narrow-band imaging. Int J Comput Assist Radiol Surg 2017; 12:2015-2021. [PMID: 28361325 PMCID: PMC5656714 DOI: 10.1007/s11548-017-1579-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/21/2017] [Indexed: 12/13/2022]
Abstract
Purpose Recent advances in endoscopy have led to new technologies with significant optical imaging improvements. Since its development a few years ago, narrow-band imaging (NBI) has already been proved useful in detecting malignant lesions and carcinoma in clinical settings of urology, gastroenterology and ENT. The potential of this technology for imaging applications of the arterial vessel wall has not been properly analysed yet, but with the observed benefits could prove valuable for this clinical use as well. Methods In order to assess the efficacy of NBI, defects such as burns and mechanical tears were created on the walls of an arterial vessel sample. Ex vivo imaging using NBI and white light imaging (WLI) were performed with rigid and flexible fibre endoscopes. Results A thorough comparison of the images proved that NBI enhances the visualisation of lesions and defects on the artery walls compared to normal WLI. Conclusion WLI provides a direct image of the vessel lumen and its anatomical shape. It is suitable for observation and documentation of intravascular therapies. NBI images are more distinct and have more contrast. This helps to detect even small defects or changes on the inner vessel wall that could provide additional information and lead to more precise and personalised therapies.
Collapse
|
56
|
Fitzpatrick LA, Berkovitz N, Dos Santos MP, Majeed N, Glikstein R, Chakraborty S, Veinot JP, Stotts G, Berthiaume A, Chatelain R. Vulnerable carotid plaque imaging and histopathology without a dedicated MRI receiver coil. Neuroradiol J 2017; 30:120-128. [PMID: 28071288 DOI: 10.1177/1971400916678244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Stroke is associated with vulnerable carotid artery plaques showing specific histopathologic features, namely a lipid-rich necrotic core, intraplaque hemorrhage, ulceration, and thin fibrous cap. While ultrasound and computed tomography (CT) can identify carotid plaques and determine the extent of stenosis, magnetic resonance imaging (MRI) provides further information regarding plaque composition and morphology. In this feasibility study, three patients with symptomatic, moderately stenosed plaques were imaged with CT angiography (CTA) and MRI (3T and 1.5T) without a dedicated receiver coil. The patients subsequently underwent carotid endarterectomy with en-bloc excision of the plaque. The CT and MR images were analyzed independently by three neuroradiologists to identify vulnerable plaque features. The images were correlated with the histopathology to confirm the findings. All three patients had one or more vulnerable plaque features on histopathology. MRI allowed for better characterization of these features when compared to CTA. The pre- and post-contrast T1-weighted (T1W) images were most helpful for identifying the lipid-rich necrotic core and thin fibrous cap, while the time of flight-magnetic resonance angiography (TOF-MRA) and contrast-enhanced (CE)-MRA were excellent for detecting plaque hemorrhage and ulceration, respectively. The 3T images showed superior spatial and contrast resolution compared to the 1.5T images for all sequences. By providing direct correlation between imaging and histopathology, this study demonstrates that 3T MRI without a dedicated surface coil is an excellent tool for assessing plaque vulnerability. In smaller hospitals or those with limited resources, it is reasonable to consider conventional MRI for patient risk stratification. Further studies are needed to determine how MRI and plaque vulnerability can be incorporated into routine clinical practice.
Collapse
Affiliation(s)
- Laura A Fitzpatrick
- 2 Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa, Canada
| | - Nadav Berkovitz
- 3 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Marlise P Dos Santos
- 1 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Medical Imaging, Ottawa, Canada; and Harvard T. H. Chan School of Public Health, Boston, USA
| | - Nevin Majeed
- 3 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Rafael Glikstein
- 3 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Santanu Chakraborty
- 3 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - John P Veinot
- 4 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Canada
| | - Grant Stotts
- 5 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Medicine, The Ottawa Hospital, University of Ottawa, Canada
| | - Alain Berthiaume
- 3 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Robert Chatelain
- 3 Ottawa Hospital Research Institute, Brain and Mind Research Institute, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| |
Collapse
|
57
|
Tang D, Yang C, Huang S, Mani V, Zheng J, Woodard PK, Robson P, Teng Z, Dweck M, Fayad ZA. Cap inflammation leads to higher plaque cap strain and lower cap stress: An MRI-PET/CT-based FSI modeling approach. J Biomech 2016; 50:121-129. [PMID: 27847118 DOI: 10.1016/j.jbiomech.2016.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
Plaque rupture may be triggered by extreme stress/strain conditions. Inflammation is also implicated and can be imaged using novel imaging techniques. The impact of cap inflammation on plaque stress/strain and flow shear stress were investigated. A patient-specific MRI-PET/CT-based modeling approach was used to develop 3D fluid-structure interaction models and investigate the impact of inflammation on plaque stress/strain conditions for better plaque assessment. 18FDG-PET/CT and MRI data were acquired from 4 male patients (average age: 66) to assess plaque characteristics and inflammation. Material stiffness for the fibrous cap was adjusted lower to reflect cap weakening causing by inflammation. Setting stiffness ratio (SR) to be 1.0 (fibrous tissue) for baseline, results for SR=0.5, 0.25, and 0.1 were obtained. Thin cap and hypertension were also considered. Combining results from the 4 patients, mean cap stress from 729 cap nodes was lowered by 25.2% as SR went from 1.0 to 0.1. Mean cap strain value for SR=0.1 was 0.313, 114% higher than that from SR=1.0 model. The thin cap SR=0.1 model had 40% mean cap stress decrease and 81% cap strain increase compared with SR=1.0 model. The hypertension SR=0.1 model had 19.5% cap stress decrease and 98.6% cap strain increase compared with SR=1.0 model. Differences of flow shear stress with 4 different SR values were limited (<10%). Cap inflammation may lead to large cap strain conditions when combined with thin cap and hypertension. Inflammation also led to lower cap stress. This shows the influence of inflammation on stress/strain calculations which are closely related to plaque assessment.
Collapse
Affiliation(s)
- Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing, China; Mathematical Sciences Department, WPI, Worcester, MA 01609, USA.
| | - Chun Yang
- Mathematical Sciences Department, WPI, Worcester, MA 01609, USA; Network Technology Research Institute, China United Network Comm. Co., Ltd., Beijing, China
| | - Sarayu Huang
- Department of Radiology, Translational and molecular imaging institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Venkatesh Mani
- Department of Radiology, Translational and molecular imaging institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Philip Robson
- Department of Radiology, Translational and molecular imaging institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, CB2 0QQ, United Kingdom
| | - Marc Dweck
- Department of Radiology, Translational and molecular imaging institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zahi A Fayad
- Department of Radiology, Translational and molecular imaging institute, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
58
|
Liu Y, Hua Y, Feng W, Ovbiagele B. Multimodality ultrasound imaging in stroke: current concepts and future focus. Expert Rev Cardiovasc Ther 2016; 14:1325-1333. [PMID: 27785921 DOI: 10.1080/14779072.2016.1254043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Stroke is a leading cause of disability and mortality worldwide. Ultrasound is a real-time imaging technique that is inexpensive, portable, non-invasive, and safe, with high diagnostic accuracy. Ultrasonic imaging can provide useful direct and indirect information about the characteristics of various vessels in the both intracranial and extracranial segments. Areas covered: In this review, we will discuss multimodal applications of ultrasonic imaging in stroke prevention and management including checking carotid intima-media thickness progression, evaluating the plaque morphology, calibrating the degree of stenosis, detecting the presence of patent foramen ovale, monitoring microembolization, and screening for stroke risk in patients with sickle cell disease. We present the conventional ultrasonography as well as the novel ultrasound techniques including gray scale median, 3-dementional ultrasound, elastography, intravascular ultrasound, and contrast-enhanced ultrasound. Expert commentary: Ultrasonography is a non-invasive, low-cost, safe, fast, and real-time imaging technology for stroke risk assessment. Each modality has its own advantage as well as limitation. Future research should be focused on developing new technologies that can improve the quality of imaging and accuracy of diagnosis.
Collapse
Affiliation(s)
- Yumei Liu
- a Department of Vascular Ultrasound , Xuanwu Hospital, Capital Medical University , Beijing , China.,b Department of Neurology, MUSC Stroke Center , Medical University of South Carolina , Charleston , USA
| | - Yang Hua
- a Department of Vascular Ultrasound , Xuanwu Hospital, Capital Medical University , Beijing , China
| | - Wuwei Feng
- b Department of Neurology, MUSC Stroke Center , Medical University of South Carolina , Charleston , USA
| | - Bruce Ovbiagele
- b Department of Neurology, MUSC Stroke Center , Medical University of South Carolina , Charleston , USA
| |
Collapse
|
59
|
Filis K, Toufektzian L, Galyfos G, Sigala F, Kourkoveli P, Georgopoulos S, Vavuranakis M, Vrachatis D, Zografos G. Assessment of the vulnerable carotid atherosclerotic plaque using contrast-enhanced ultrasonography. Vascular 2016; 25:316-325. [PMID: 27580821 DOI: 10.1177/1708538116665734] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Carotid atherosclerosis represents a primary cause for cerebrovascular ischemic events and its contemporary management includes surgical revascularization for moderate to severe symptomatic stenoses. However, the role of invasive therapy seems to be questioned lately for asymptomatic cases. Numerous reports have suggested that the presence of neovessels within the atherosclerotic plaque remains a significant vulnerability factor and over the last decade imaging modalities have been used to identify intraplaque neovascularization in an attempt to risk-stratify patients and offer management guidance. Contrast-enhanced ultrasonography of the carotid artery is a relatively novel diagnostic tool that exploits resonated ultrasound waves from circulating microbubbles. This property permits vascular visualization by producing superior angiography-like images, and allows the identification of vasa vasorum and intraplaque microvessels. Moreover, plaque neovascularization has been associated with plaque vulnerability and ischemic symptoms lately as well. At the same time, attempts have been made to quantify contrast-enhanced ultrasonography signal using sophisticated software packages and algorithms, and to correlate it with intraplaque microvascular density. The aim of this review was to collect all recent data on the characteristics, performance, and prognostic role of contrast-enhanced ultrasonography regarding carotid stenosis management, and to produce useful conclusions for clinical practice.
Collapse
Affiliation(s)
- Konstantinos Filis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Levon Toufektzian
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - George Galyfos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Fragiska Sigala
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Panagiota Kourkoveli
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Manolis Vavuranakis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - Dimitrios Vrachatis
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| | - George Zografos
- First Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
| |
Collapse
|
60
|
Abstract
Cardiovascular disease (CVD) primarily caused by atherosclerosis is a major cause of death and disability in developed countries. Sonographic carotid intima-media thickness (CIMT) is widely studied as a surrogate marker for detecting subclinical atherosclerosis for risk prediction and disease progress to guide medical intervention. However, there is no standardized CIMT measurement methodology in clinical studies resulting in inconsistent findings, thereby undermining the clinical value of CIMT. Increasing evidences show that CIMT alone has weak predictive value for CVD while CIMT including plaque presence consistently improves the predictive power. Quantification of plaque burden further enhances the predictive power beyond plaque presence. Sonographic carotid plaque characteristics have been found to be predictive of cerebral ischaemic events. With advances in ultrasound technology, enhanced assessment of carotid plaques is feasible to detect high-risk/vulnerable plaques, and provide risk assessment for ischemic stroke beyond measurement of luminal stenosis.
Collapse
Affiliation(s)
- Stella Sin Yee Ho
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| |
Collapse
|