High-Resolution CT Imaging of Carotid Artery Atherosclerotic Plaques

Abstract

BACKGROUND AND PURPOSE:Plaque morphologic features have been suggested as a complement to luminal narrowing measurements for assessing the risk of stroke associated with carotid atherosclerotic disease, giving rise to the concept of "vulnerable plaque." The purpose of this study was to evaluate the ability of multidetector-row CT angiography (CTA) to assess the composition and characteristics of carotid artery atherosclerotic plaques with use of histologic examination as the gold standard.

CT Angiographic Features of Symptom-Producing Plaque in Moderate-Grade Carotid Artery Stenosis

“…Although there are studies using alternative CTA imaging strategies to assess unstable or vulnerable carotid plaque, we believe that the technique we used has 3 significant advantages over previously studied CTA techniques. First, plaque thickness measurements require no additional postprocessing, unlike some prior methods 18,19 that have required customized postprocessing software not routinely available or widely used in clinical practice. Similarly, the technique used in our study does not require the measurement of Hounsfield units, which have been shown to be poor discriminators among specific plaque elements, given overlapping attenuation of in vivo atherosclerotic plaque components such as hemorrhage, fibrosis, and lipids.…”

Imaging of the Carotid Artery Vulnerable Plaque

“…e, f Smooth plaque ulcers (white arrowheads) for CT and US respectively [48][49][50] by distinguishing different patterns on T1-w, T2-w, PD, and TOF images. Authors tried to identify IPH using CT and found a strong correlation between very low HU value and IPH [51,52].…”

An evaluation of dual source computed tomography used with the de Weert classification to detect vulnerable plaque, using IVUS virtual histology as a standard of reference

“…This overlap severely limits the reliability of individual pixel Hounsfield readings on key components of vulnerable plaque. 29 At present, there is no satisfactory method for direct assessment of plaque morphology in CT. 30,31 This is the reason the current authors considered adapting de Weert classification for DSCT data analysis, which uses plaque surface morphology assessment. The indirect approach is, in the current authors' opinion, a feasible and reliable tool for clinical use.…”