Contemporary carotid imaging: from degree of XXXX to plaque vulnerability.

@entity1 @entity32 @entity64 @entity548 @entity63 @entity39 @entity1066 @entity2295 @entity2791 @entity397 @entity850 @entity543 @entity385
UNASSIGNED: Carotid @entity2791 is a well-established risk factor of @entity385 , contributing to up to 10%-20% of @entity64 or transient @entity63 attacks. Many clinical trials over the last 20 years have used measurements of @entity543 as a means to risk stratify @entity1 . However, with improvements in vascular imaging techniques such as CT angiography and MR angiography, ultrasonography, and PET/CT, it is now possible to risk stratify @entity1 , not just on the degree of @entity543 but also on how vulnerable the plaque is to @entity397 , resulting in @entity385 . These imaging techniques are ushering in an emerging paradigm shift that allows for risk stratifications based on the presence of imaging features such as @entity548 ( @entity548 ), plaque @entity1066 , @entity2295 , fibrous cap thickness, and presence of a lipid-rich @entity39 core (LRNC). It is important for the neurosurgeon to be aware of these new imaging techniques that allow for improved @entity1 risk stratification and outcomes. For example, a @entity1 with a low-grade @entity850 but an @entity1066 may benefit more from a revascularization procedure than a @entity1 with a stable 70% asymptomatic @entity850 with a thick fibrous cap. This review summarizes the current state-of-the-art advances in carotid plaque imaging. Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying @entity548 , @entity1066 , LRNC, and @entity32 . However, MRI is limited due to time constraints. CT also allows for high-resolution imaging and can accurately detect @entity1066 and calcification, but cannot reliably differentiate LRNC from @entity548 . PET/CT is an effective technique to identify active @entity32 within the plaque, but it does not allow for assessment of anatomy, @entity1066 , @entity548 , or LRNC. Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, @entity548 , and @entity1066 compared with MRI. Also summarized is how these advanced imaging techniques are being used in clinical practice to risk stratify @entity1 with low- and high-grade @entity543 . For example, identification of @entity548 on MRI in @entity1 with low-grade @entity543 is a risk factor for failure of medical therapy, and studies have shown that such @entity1 may fair better with carotid endarterectomy (CEA). MR plaque imaging has also been found to be useful in identifying revascularization candidates who would be better candidates for CEA than carotid artery stenting (CAS), as high intraplaque signal on time of flight imaging is associated with vulnerable plaque and increased rates of adverse events in @entity1 undergoing CAS but not CEA.
