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5 results

  • Hemorrhagic Plaques in Mild Carotid Stenosis: The Risk of Stroke

  • Max Scheffler, Alain Pellaton, José Boto, Isabelle Barnaure, Bénédicte M. Delattre, Jorge Remuinan, Roman Sztajzel, Karl-Olof Lövblad, Maria Isabel Vargas
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 48 / Issue 2 / March 2021
    Published online by Cambridge University Press:
    17 August 2020, pp. 218-225
    • Article
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  • Objectives:

    Embolic ischemic strokes cause significant mortality and morbidity worldwide. It has been proposed that some of these strokes are due to unstable carotid plaques with intraplaque hemorrhage (IPH) but a low overall degree of stenosis. Our aim was to test a fat-saturated T1-weighted (T1WI) black-blood sequence on MRI for the detection of IPH in symptomatic individuals and to quantify the relation between IPH, severity of stenoses, and ischemic brain lesions.

    Materials and Methods:

    Sixty-two patients were examined by 3T MRI. Sequences included brain diffusion-weighted imaging (DWI) as well as 3D turbo spin echo (TSE) fat-saturated black-blood T1 of the carotid bifurcations, to detect IPH as a focal intraplaque hyperintensity. Both carotid arteries were analyzed in each patient. The North American Symptomatic Carotid Endarterectomy Trial scale was used for quantification of stenosis degree.

    Results:

    Thirty-six out of 62 patients (mean age, 74) showed brain ischemia on DWI. Fifteen of these 36 patients (42%) had associated ipsilateral IPH at the carotid bifurcation or the proximal internal carotid artery. Mean degree of stenosis in this group was 50%. In 21 patients with ischemia without IPH, the mean degree of stenosis was 44%.

    Conclusions:

    MRI with 3D TSE fat-saturated black-blood T1 technique is a safe, reliable, and noninvasive tool for the detection of IPH. A high percentage (42%) of ischemic events in patients with low- to moderate-degree stenosis were associated with IPH, an easily detectable imaging biomarker of plaque vulnerability. The ability to confirm IPH by MRI may help stratify patients into different risk and treatment groups in the future.

  • 16 - Assessment of carotid plaque with conventional ultrasound

  • from Morphological plaque imaging
  • Edited by Jonathan Gillard, University of Cambridge, Martin Graves, University of Cambridge, Thomas Hatsukami, University of Washington, Chun Yuan, University of Washington
  • Book:
    Carotid Disease
    Published online:
    03 December 2009
    Print publication:
    07 December 2006, pp 208-222

  • Summary

    This chapter discusses the clinical merits and limitations of conventional ultrasound (US) techniques for evaluation of both early and advanced carotid disease. A number of complementary ultrasonographic techniques such as B-mode scanning, duplex sonography, and contrast harmonic imaging are available for imaging of the carotid arteries. The first morphological abnormalities of arterial walls can be imaged by B-mode ultrasonography. This technique is one of the best methods for detection of early stages of atherosclerotic disease, because it is easily applicable, readily available, and demonstrates the wall structure with better resolution than magnetic resonance angiography or conventional angiography. In the initial period of cerebrovascular ultrasonographic insonation, the ophthalmic artery was used as an indirect test for detection of significant carotid artery stenosis. Targeted US techniques combine US imaging technology with specific contrast agents for the assessment of molecular or genetic signatures for disease.

  • 12 - Computed tomographic angiography of carotid artery stenosis

  • from Luminal imaging techniques
  • Edited by Jonathan Gillard, University of Cambridge, Martin Graves, University of Cambridge, Thomas Hatsukami, University of Washington, Chun Yuan, University of Washington
  • Book:
    Carotid Disease
    Published online:
    03 December 2009
    Print publication:
    07 December 2006, pp 158-165

  • Summary

    Computerized tomography angiography (CTA) is increasingly used in the diagnosis of carotid artery stenosis, along with other noninvasive tests such as duplex ultrasound (DUS) or magnetic resonance angiography (MRA). The use of intravenous iodinated contrast in CTA allows excellent images of the lumen of the arteries. CTA visualizes the wall of the arteries and the morphology of the atherosclerotic plaque. Each of the different postprocessing techniques used to construct a 3D angiographic display of the artery have their particular strengths and weaknesses in imaging carotid artery stenosis. Maximum intensity projection (MIP) reconstructions are often used in CTA because they can rapidly automatically be generated. The projection, lateral, posteroanterior, or oblique, which shows the most severe stenosis, is used for establishing the degree of stenosis. Multislice CT-scanning together with other technical developments will probably further improve the diagnostic accuracy of CTA.