Advertisement

Current Imaging Approaches and Challenges in the Assessment of Carotid Artery Disease

  • Krishnan Ravindran
  • Waleed BrinijikiEmail author
  • J. Kevin DeMarco
  • John HustonIII
Chapter

Abstract

Modern advances now allow for carotid plaque vulnerability to be assessed through noninvasive imaging techniques. Further paradigm shift has expanded imaging evaluation of carotid disease beyond stenosis measurement to thorough evaluation of carotid plaque characteristics. Key imaging features such as plaque ulceration, neovascularity, thickness of fibrous cap, and the presence of intraplaque hemorrhage can now be used to stratify risk of global plaque rupture. In this chapter, we focus on the three primary imaging modalities used to assess carotid plaque (MRI, CT, and ultrasound) and focus on imaging features of lipid-rich necrotic core and intraplaque hemorrhage on each. Additionally we discuss novel techniques within each modality used to evaluate plaque and consider relative merits.

Keywords

Soft plaque Necrotic core Intraplaque hemorrhage Fibrous cap CTA MRA Ultrasound 

Notes

Disclaimer

The views expressed in this chapter are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or US Government.

The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the author, DoD, or any component agency.

References

  1. 1.
    Brinjikji W, Lehman VT, Huston J 3rd, et al. The association between carotid intraplaque hemorrhage and outcomes of carotid stenting: a systematic review and meta-analysis. J Neurointerv Surg. 2017;9(9):837–42.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Kerwin WS, O'Brien KD, Ferguson MS, Polissar N, Hatsukami TS, Yuan C. Inflammation in carotid atherosclerotic plaque: a dynamic contrast-enhanced MR imaging study. Radiology. 2006;241(2):459–68.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Millon A, Mathevet JL, Boussel L, et al. High-resolution magnetic resonance imaging of carotid atherosclerosis identifies vulnerable carotid plaques. J Vasc Surg. 2013;57(4):1046–1051.e1042.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    den Hartog AG, Bovens SM, Koning W, et al. Current status of clinical magnetic resonance imaging for plaque characterisation in patients with carotid artery stenosis. Eur J Vasc Endovasc Surg. 2013;45(1):7–21.CrossRefGoogle Scholar
  5. 5.
    Chan JM, Monaco C, Wylezinska-Arridge M, Tremoleda JL, Gibbs RG. Imaging of the vulnerable carotid plaque: biological targeting of inflammation in atherosclerosis using iron oxide particles and MRI. Eur J Vasc Endovasc Surg. 2014;47(5):462–9.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Chu B, Kampschulte A, Ferguson MS, et al. Hemorrhage in the atherosclerotic carotid plaque: a high-resolution MRI study. Stroke. 2004;35(5):1079–84.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Moody AR, Murphy RE, Morgan PS, et al. Characterization of complicated carotid plaque with magnetic resonance direct thrombus imaging in patients with cerebral ischemia. Circulation. 2003;107(24):3047–52.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Moody AR. Magnetic resonance direct thrombus imaging. J Thromb Haemost. 2003;1(7):1403–9.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Singh N, Moody AR, Roifman I, Bluemke DA, Zavodni AE. Advanced MRI for carotid plaque imaging. Int J Cardiovasc Imaging. 2016;32(1):83–9.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Kampschulte A, Ferguson MS, Kerwin WS, et al. Differentiation of intraplaque versus juxtaluminal hemorrhage/thrombus in advanced human carotid atherosclerotic lesions by in vivo magnetic resonance imaging. Circulation. 2004;110(20):3239–44.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Yim YJ, Choe YH, Ko Y, et al. High signal intensity halo around the carotid artery on maximum intensity projection images of time-of-flight MR angiography: a new sign for intraplaque hemorrhage. J Magn Reson Imaging. 2008;27(6):1341–6.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Chu B, Hatsukami TS, Polissar NL, et al. Determination of carotid artery atherosclerotic lesion type and distribution in hypercholesterolemic patients with moderate carotid stenosis using noninvasive magnetic resonance imaging. Stroke. 2004;35(11):2444–8.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Singh N, Moody AR, Gladstone DJ, et al. Moderate carotid artery stenosis: MR imaging-depicted intraplaque hemorrhage predicts risk of cerebrovascular ischemic events in asymptomatic men. Radiology. 2009;252(2):502–8.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Saam T, Hetterich H, Hoffmann V, et al. Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging. J Am Coll Cardiol. 2013;62(12):1081–91.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Cappendijk VC, Heeneman S, Kessels AG, et al. Comparison of single-sequence T1w TFE MRI with multisequence MRI for the quantification of lipid-rich necrotic core in atherosclerotic plaque. J Magn Reson Imaging. 2008;27(6):1347–55.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Yuan C, Kerwin WS, Ferguson MS, et al. Contrast-enhanced high resolution MRI for atherosclerotic carotid artery tissue characterization. J Magn Reson Imaging. 2002;15(1):62–7.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Cai J, Hatsukami TS, Ferguson MS, et al. In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque: comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology. Circulation. 2005;112(22):3437–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Serfaty JM, Chaabane L, Tabib A, Chevallier JM, Briguet A, Douek PC. Atherosclerotic plaques: classification and characterization with T2-weighted high-spatial-resolution MR imaging-- an in vitro study. Radiology. 2001;219(2):403–10.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Qiao Y, Etesami M, Astor BC, Zeiler SR, Trout HH, Wasserman BA. Carotid plaque neovascularization and hemorrhage detected by MR imaging are associated with recent cerebrovascular ischemic events. AJNR Am J Neuroradiol. 2012;33(4):755–60.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Gupta A, Baradaran H, Schweitzer AD, et al. Carotid plaque MRI and stroke risk: a systematic review and meta-analysis. Stroke. 2013;44(11):3071–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Walker LJ, Ismail A, McMeekin W, Lambert D, Mendelow AD, Birchall D. Computed tomography angiography for the evaluation of carotid atherosclerotic plaque: correlation with histopathology of endarterectomy specimens. Stroke. 2002;33(4):977–81.PubMedCrossRefGoogle Scholar
  22. 22.
    de Weert TT, Ouhlous M, Meijering E, et al. In vivo characterization and quantification of atherosclerotic carotid plaque components with multidetector computed tomography and histopathological correlation. Arterioscler Thromb Vasc Biol. 2006;26(10):2366–72.PubMedCrossRefGoogle Scholar
  23. 23.
    Wintermark M, Jawadi SS, Rapp JH, et al. High-resolution CT imaging of carotid artery atherosclerotic plaques. AJNR Am J Neuroradiol. 2008;29(5):875–82.PubMedCrossRefGoogle Scholar
  24. 24.
    Trelles M, Eberhardt KM, Buchholz M, et al. CTA for screening of complicated atherosclerotic carotid plaque--American Heart Association type VI lesions as defined by MRI. AJNR Am J Neuroradiol. 2013;34(12):2331–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Sheahan M, Ma X, Paik D, et al. Atherosclerotic plaque tissue: noninvasive quantitative assessment of characteristics with software-aided measurements from conventional CT angiography. Radiology. 2018;286(2):622–31.PubMedCrossRefGoogle Scholar
  26. 26.
    JM UK-I, Fox AJ, Aviv RI, et al. Characterization of carotid plaque hemorrhage: a CT angiography and MR intraplaque hemorrhage study. Stroke. 2010;41(8):1623–9.CrossRefGoogle Scholar
  27. 27.
    Saba L, Francone M, Bassareo PP, et al. CT attenuation analysis of carotid intraplaque hemorrhage. AJNR Am J Neuroradiol. 2018;39(1):131–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Eisenmenger LB, Aldred BW, Kim SE, et al. Prediction of carotid intraplaque hemorrhage using adventitial calcification and plaque thickness on CTA. AJNR Am J Neuroradiol. 2016;37(8):1496–503.PubMedCrossRefGoogle Scholar
  29. 29.
    Gupta A, Kesavabhotla K, Baradaran H, et al. Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis. Stroke. 2015;46(1):91–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Brinjikji W, Rabinstein AA, Lanzino G, et al. Ultrasound characteristics of symptomatic carotid plaques: a systematic review and meta-analysis. Cerebrovasc Dis. 2015;40(3–4):165–74.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Polak JF, Shemanski L, O'Leary DH, et al. Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults aged 65 years or older. Cardiovascular Health Study. Radiology. 1998;208(3):649–54.PubMedCrossRefGoogle Scholar
  32. 32.
    Reiter M, Horvat R, Puchner S, et al. Plaque imaging of the internal carotid artery - correlation of B-flow imaging with histopathology. AJNR Am J Neuroradiol. 2007;28(1):122–6.PubMedGoogle Scholar
  33. 33.
    Gray-Weale AC, Graham JC, Burnett JR, Byrne K, Lusby RJ. Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg. 1988;29(6):676–81.Google Scholar
  34. 34.
    el-Barghouty N, Nicolaides A, Bahal V, Geroulakos G, Androulakis A. The identification of the high risk carotid plaque. Eur J Vasc Endovasc Surg. 1996;11(4):470–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Cires-Drouet RS, Mozafarian M, Ali A, Sikdar S, Lal BK. Imaging of high-risk carotid plaques: ultrasound. Semin Vasc Surg. 2017;30(1):44–53.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Nakamura T, Tsutsumi Y, Shimizu Y, Uchiyama S. Ulcerated carotid plaques with ultrasonic echolucency are causatively associated with thromboembolic cerebrovascular events. J Stroke Cerebrovasc Dis. 2013;22(2):93–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Beach KW, Leotta DF, Zierler RE. Carotid Doppler velocity measurements and anatomic stenosis: correlation is futile. Vasc Endovasc Surg. 2012;46(6):466–74.CrossRefGoogle Scholar
  38. 38.
    Arai D, Yamaguchi S, Murakami M, et al. Characteristics of carotid plaque findings on ultrasonography and black blood magnetic resonance imaging in comparison with pathological findings. Acta Neurochir Suppl. 2011;112:15–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Watanabe Y, Nagayama M, Suga T, et al. Characterization of atherosclerotic plaque of carotid arteries with histopathological correlation: vascular wall MR imaging vs. color Doppler ultrasonography (US). J Magn Reson Imaging. 2008;28(2):478–85.PubMedCrossRefGoogle Scholar
  40. 40.
    Vavuranakis M, Sigala F, Vrachatis DA, et al. Quantitative analysis of carotid plaque vasa vasorum by CEUS and correlation with histology after endarterectomy. VASA Zeitschrift fur Gefasskrankheiten. 2013;42(3):184–95.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Xiong L, Deng YB, Zhu Y, Liu YN, Bi XJ. Correlation of carotid plaque neovascularization detected by using contrast-enhanced US with clinical symptoms. Radiology. 2009;251(2):583–9.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Staub D, Patel MB, Tibrewala A, et al. Vasa vasorum and plaque neovascularization on contrast-enhanced carotid ultrasound imaging correlates with cardiovascular disease and past cardiovascular events. Stroke. 2010;41(1):41–7.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Owen DR, Shalhoub J, Miller S, et al. Inflammation within carotid atherosclerotic plaque: assessment with late-phase contrast-enhanced US. Radiology. 2010;255(2):638–44.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Ten Kate GL, van den Oord SC, Sijbrands EJ, et al. Current status and future developments of contrast-enhanced ultrasound of carotid atherosclerosis. J Vasc Surg. 2013;57(2):539–46.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Landry A, Spence JD, Fenster A. Measurement of carotid plaque volume by 3-dimensional ultrasound. Stroke. 2004;35(4):864–9.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Bucek RA, Reiter M, Dirisamer A, et al. Three-dimensional color Doppler sonography in carotid artery stenosis. AJNR Am J Neuroradiol. 2003;24(7):1294–9.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Hossain MM, AlMuhanna K, Zhao L, Lal BK, Sikdar S. Semiautomatic segmentation of atherosclerotic carotid artery wall volume using 3D ultrasound imaging. Med Phys. 2015;42(4):2029–43.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Zhang Q, Li C, Zhou M, et al. Quantification of carotid plaque elasticity and intraplaque neovascularization using contrast-enhanced ultrasound and image registration-based elastography. Ultrasonics. 2015;62:253–62.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Huang C, Pan X, He Q, et al. Ultrasound-based carotid elastography for detection of vulnerable atherosclerotic plaques validated by magnetic resonance imaging. Ultrasound Med Biol. 2016;42(2):365–77.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Roy Cardinal MH, Heusinkveld MHG, Qin Z, et al. Carotid artery plaque vulnerability assessment using noninvasive ultrasound elastography: validation with MRI. AJR Am J Roentgenol. 2017;209(1):142–51.PubMedCrossRefGoogle Scholar
  51. 51.
    Griffin MB, Kyriacou E, Pattichis C, et al. Juxtaluminal hypoechoic area in ultrasonic images of carotid plaques and hemispheric symptoms. J Vasc Surg. 2010;52(1):69–76.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Kakkos SK, Griffin MB, Nicolaides AN, et al. The size of juxtaluminal hypoechoic area in ultrasound images of asymptomatic carotid plaques predicts the occurrence of stroke. J Vasc Surg. 2013;57(3):609–618.e601; discussion 617-608.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Krishnan Ravindran
    • 1
  • Waleed Brinijiki
    • 1
    Email author
  • J. Kevin DeMarco
    • 2
    • 3
  • John HustonIII
    • 1
  1. 1.Department of RadiologyMayo ClinicRochesterUSA
  2. 2.Department of RadiologyWalter Reed National Military Medical CenterBethesdaUSA
  3. 3.Department of RadiologyUniformed Services University of the Health SciencesBethesdaUSA

Personalised recommendations