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MRI of carotid atherosclerosis: clinical implications and future directions

Nature Reviews Cardiology volume 7, pages 165–173 (2010)Cite this article

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Abstract

Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood flow, and inflammation. Despite recent advances in understanding of plaque biology, diagnosis, and treatment, atherosclerosis remains a leading cause of morbidity and mortality. Further research into the development and validation of reliable indicators of the high-risk individual is greatly needed. Carotid MRI is a histologically validated, noninvasive imaging method that can track disease progression and regression, and quantitatively evaluate a spectrum of parameters associated with in vivo plaque morphology and composition. Intraplaque hemorrhage and the lipid-rich necrotic core are the best indicators of lesion severity currently visualized by carotid MRI. However, MRI methods capable of imaging other important aspects of carotid atherosclerotic disease in vivo—including inflammation, neovascularization, and mechanical forces—are emerging and may aid in advancing our understanding of the pathophysiology of this multifactorial disease.

Key Points

  • Carotid atherosclerosis is a multifactorial disease attributable to plaque composition, inflammation, neovasculature, and mechanical stress

  • Carotid MRI enables the in vivo monitoring of atherosclerotic disease

  • Carotid intraplaque hemorrhage has been associated with accelerated plaque growth, luminal narrowing, and development of symptomatic events

  • The lipid-rich necrotic core in the carotid artery represents the strongest in vivo predictor of future surface disruption

  • Emerging carotid MRI techniques are permitting the in vivo assessment of inflammation, neovasculature, and mechanical stress

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Figure 1: In vivo evidence of the effects of IPH.
Figure 2: Development of a surface disruption in the right carotid artery.
Figure 3: Change in the LRNC in response to statin therapy.

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Authors and Affiliations

  1. Department of Radiology, University of Washington, 815 Mercer Street, Box 358050, Seattle, 98109, WA, USA

    Hunter R. Underhill & Chun Yuan

  2. Department of Surgery, University of Washington, 815 Mercer Street, Box 358050, Seattle, 98109, WA, USA

    Thomas S. Hatsukami

  3. The Translational and Molecular Imaging Institute, Eva and Morris Feld Imaging Science Laboratories, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1234, New York, 10029, NY, USA

    Zahi A. Fayad

  4. The Centro Nacional de Investigaciones Cardiovasculares (CNIC), Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Melchor Fernández Almagro, 3, Madrid, E-28029, Spain

    Valentin Fuster

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Correspondence to Hunter R. Underhill.

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Underhill, H., Hatsukami, T., Fayad, Z. et al. MRI of carotid atherosclerosis: clinical implications and future directions. Nat Rev Cardiol 7, 165–173 (2010). https://doi.org/10.1038/nrcardio.2009.246

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  • DOI: https://doi.org/10.1038/nrcardio.2009.246

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