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Purpose To develop and validate a combined model incorporating conventional clinical and imaging characteristics and radiomics signatures based on head and neck computed tomography angiography (CTA) to assess plaque vulnerability. Methods We retrospectively analyzed 167 patients with carotid atherosclerosis who underwent head and neck CTA and brain magnetic resonance imaging (MRI) within 1 month. Clinical risk factors and conventional plaque characteristics were evaluated, and radiomic features were extracted from the carotid plaques. The conventional, radiomics and combined models were developed using fivefold cross-validation. Model performance was evaluated using receiver operating characteristic (ROC), calibration, and decision curve analyses. Results Patients were divided into symptomatic (n = 70) and asymptomatic (n = 97) groups based on MRI results. Homocysteine (odds ratio, OR 1.057; 95% confidence interval, CI 1.001–1.116), plaque ulceration (OR 6.106; 95% CI 1.933–19.287), and carotid rim sign (OR 3.285; 95% CI 1.203–8.969) were independently associated with symptomatic status and were used to construct the conventional model and s radiomic features were retained to establish the radiomics model. Radiomics scores incorporated with conventional characteristics were used to establish the combined model. The area under the ROC curve (AUC) of the combined model was 0.832, which outperformed the conventional (AUC = 0.767) and radiomics (AUC = 0.797) models. Calibration and decision curves analysis showed that the combined model was clinically useful. Conclusion Radiomics signatures of carotid plaque on CTA can well predict plaque vulnerability, which may provide additional value to identify high-risk patients and improve outcomes.

<b><i>Introduction:</i></b> The purpose of this study was to analyze the difference in clinical and aortic morphological features between the bovine aortic arch and normal aortic arch in patients with acute type B aortic dissection (aTBAD). <b><i>Methods:</i></b> A total of 133 patients diagnosed with aTBAD were retrospectively collected. Based on aortic arch morphology, they were divided into the bovine aortic arch group (<i>n</i> = 20) and the normal aortic arch group (<i>n</i> = 113). Aortic morphological features were assessed on computed tomographic angiography. Clinical and aortic morphological features were then compared between the bovine aortic arch and normal aortic arch groups. <b><i>Results:</i></b> Patients in the bovine aortic arch group were significantly younger and with higher weight and BMI than the normal aortic arch group (<i>p</i> &lt; 0.001, <i>p</i> = 0.045, and <i>p</i> = 0.016, respectively). The total aortic length in the bovine aortic arch group was significantly shorter than that in the normal aortic arch group (<i>p</i> = 0.039). The tortuosity of descending thoracic aorta, the tortuosity of descending aorta, and the angulation of aortic arch were significantly lower in the bovine aortic arch group (<i>p</i> = 0.004, <i>p</i> = 0.015, and <i>p</i> = 0.023, respectively). The width of descending aorta, the height of aorta arch, and the angle of ascending aorta were significantly smaller in the bovine aortic arch group (<i>p</i> = 0.045, <i>p</i> = 0.044, and <i>p</i> = 0.042, respectively). <b><i>Conclusion:</i></b> When the aTBAD occurred, patients with bovine aortic arch were prone to be younger and with higher BMI than those with normal aortic arch. The aortic curvature and the total aortic length were lower in patients with bovine aortic arch.