CT and MR Imaging of Carotid Wall and Plaque

Imaging of the carotid artery wall is the focus of several ongoing research studies
that are investigating the optimal approach to identify so-called “vulnerable
plaques”. Even when standard arterial luminal imaging fails to indicate a stenosis
in stroke patients, a non-stenotic plaque may be responsible for the stroke. Indeed,
over the past decade there has been a paradigm shift in the diagnosis and risk
stratification of patients with carotid artery disease, whereby nowadays more emphasis
is put on plaque characterization, mainly by using computed tomography
(CT) and magnetic resonance (MR), in addition to the usual assessment of stenosis
and surface irregularities. In this review, we will discuss current state-of-the-art
CT and MR techniques to characterize vulnerable plaques and summarize current
developments in imaging-based assessment of carotid plaques, in order to identify
ideal candidates for revascularization and to monitor the effects of medical therapy.