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  • Review Article
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Noninvasive imaging of atheromatous carotid plaques

Nature Reviews Cardiology volume 6, pages 200–209 (2009)Cite this article

Abstract

Atherothrombosis is a systemic disease of the arterial wall that affects the carotid, coronary, and peripheral vascular beds, and the aorta. This condition is associated with complications such as stroke, myocardial infarction, and peripheral vascular disease, which usually result from unstable atheromatous plaques. The study of atheromatous plaques can provide useful information about the natural history and progression of the disease, and aid in the selection of appropriate treatment. Plaque imaging can be crucial in achieving this goal. In this Review, we focus on the various noninvasive imaging techniques that are being used for morphological and functional assessment of carotid atheromatous plaques in the clinical setting.

Key Points

  • Atherosclerosis is a systemic inflammatory disease that interacts with thrombosis and affects various vascular beds

  • Carotid atheroma imaging can offer considerable insight into the underlying pathogenesis of the disease, help us understand the natural history of atherothrombosis, and facilitate the assessment of pharmacotherapies

  • At present, no ideal imaging technique exists for the assessment of carotid plaque, as each modality has benefits and limitations; however, MRI and nuclear imaging seem to hold considerable promise for the future

  • Advances in nanotechnology could also substantially improve carotid plaque imaging

  • Research should focus on the development of imaging techniques to predict those patients at high risk for future ischemic cerebrovascular events

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Figure 1: MRI (time-of-flight) of the left and right carotid arteries.
Figure 2: Axial black-blood MRI of right internal carotid artery.
Figure 3: Axial T1-weighted MRI of right internal carotid artery, which shows fibrous cap rupture and intraplaque hemorrhage.
Figure 4: Complex plaque rapture.
Figure 5: Magnetic resonance direct thrombus image (coronal axis) of a complicated thrombotic plaque (red circle) in left internal carotid artery.
Figure 6: MRI of a carotid plaque.
Figure 7: T2-weighted MRI of a carotid atheroma.
Figure 8: Comparison of stress distributions within plaques of symptomatic and asymptomatic patients.
Figure 9: Carotid atheroma in the left internal carotid artery.

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Acknowledgements

U Sadat is funded by joint clinical research training fellowship of Medical Research Council (UK) and Royal College of Surgeons of England.

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Authors and Affiliations

  1. U Sadat is a Clinical Research Associate in the Department of Radiology, Z-Y Li is a Senior Fellow in the Department of Radiology, TY Tang is a Vascular Surgery Registrar and JH Gillard is Professor of Neuroradiology in the University Department of Radiology, and an honorary Research Registrar in the Cambridge Vascular Unit, MJ Graves is the Lead Magnetic Resonance Physicist, all at the Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,

    Umar Sadat, Zhi-Yong Li, Martin J Graves, Tjun Y Tang & Jonathan H Gillard

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  1. Umar Sadat
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Correspondence to Umar Sadat.

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Supplementary Table 1

Conventional and Modified AHA Classification of Atherosclerotic Plaque (DOC 28 kb)

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Sadat, U., Li, ZY., Graves, M. et al. Noninvasive imaging of atheromatous carotid plaques. Nat Rev Cardiol 6, 200–209 (2009). https://doi.org/10.1038/ncpcardio1455

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