Diagnostic Imaging ; trends ; Humans ; Plaque, Atherosclerotic ; diagnosis

Coronary artery disease (CAD) is the leading cause of morbidity and mortality worldwide. Over the last decade coronary computed tomography angiography (CCTA) has gained wide acceptance as a reliable, cost-effective and non-invasive modality for diagnosis and prognostication of CAD. Use of CCTA is now expanding to characterization of plaque morphology and identification of vulnerable plaque. Additionally, CCTA is developing as a non-invasive modality to monitor plaque progression, which holds future potential in individualizing treatment. In this review, we discuss the role of CCTA in diagnosis and management of CAD. Additionally, we discuss the recent advancements and the potential clinical applications of CCTA in management of CAD.
Angiography ; Atherosclerosis ; Coronary Artery Disease ; Diagnosis ; Mortality ; Plaque, Atherosclerotic

Humans ; Magnetic Resonance Imaging ; trends ; Molecular Imaging ; trends ; Plaque, Atherosclerotic ; diagnosis

OBJECTIVETo assess the reproducibility of 3.0 T high-resolution magnetic resonance imaging (HR MRI) for evaluation of atherosclerotic stenosis in the middle cerebral artery (MCA).

METHODSFrom February, 2011 to December, 2013, 66 consecutive patients with MCA-M1 atherosclerotic stenosis (50%-99%) confirmed by digital subtractive angiography (DSA) received examinations with 3.0 T HR MRI for measurement of the vessel area (VA) and lumen area (LA) at the maximum narrow site (VA(narrow) and LA(narrow)) and the reference site (VA(reference) and LA(reference)) as well as the plaque distribution (ventral, dorsal, superior, and inferior). Two independent readers reviewed all the images and one reader reevaluated these images 4 weeks later. The inter- and intra-observer reproducibility was evaluated using the intraclass correlation coefficient (ICC).

RESULTSThe measurements of VA(narrow), VA(reference), and LA(reference) using HR MRI showed excellent inter- (ICC=0.801, 0.843, and 0.808, respectively) and intra-observer reproducibility (ICC=0.811, 0.916, and 0.958, respectively), but the measurement of LA(narrow) had only moderate inter- and intra-observer reproducibility (ICC=0.584 and 0.625, respectively). For plaque distribution analysis (ventral, dorsal, superior, and inferior plaques), HR MRI also showed excellent inter- (ICC=0.856, 0.836, 0.791, and 0.905, respectively) and intra-observer reproducibility (ICC=0.876, 0.827, 0.825, and 0.950, respectively).

CONCLUSIONHR MRI shows good inter- and intra-observer reproducibility in identifying MCA-M1 atherosclerotic plaque distribution and vessel and lumen measurements, but its reliability for lumen area measurement at the maximum narrowing site needs to be improved.

Constriction, Pathologic ; Humans ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; pathology ; Plaque, Atherosclerotic ; diagnosis ; Reproducibility of Results

Contrast-enhanced ultrasonography of the carotids has recently emerged as a complementary examination to conventional carotid Doppler ultrasonography. It is an examination providing improved visualization of the vascular lumen, more accurate and detailed delineation of the vascular wall, and identification of atherosclerotic plaques. Moreover, contrast-enhanced ultrasonography has specific advantages over conventional ultrasonography and plays an important role in the diagnosis of the vulnerable carotid plaque, as it can identify intraplaque neovascularization and carotid plaque ulceration. Given the specific advantages and improved imaging of the carotids provided by this method, radiologists should be familiar with it. This pictorial essay illustrates the advantages of this technique and discusses its value in the imaging of carotid arteries.
Carotid Arteries ; Carotid Stenosis ; Contrast Media ; Diagnosis ; Plaque, Atherosclerotic ; Ulcer ; Ultrasonography* ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color

Vessel wall imaging can depict the morphologies of atherosclerotic plaques, arterial walls, and surrounding structures in the intracranial and cervical carotid arteries beyond the simple luminal changes that can be observed with traditional luminal evaluation. Differentiating vulnerable from stable plaques and characterizing atherosclerotic plaques are vital parts of the early diagnosis, prevention, and treatment of stroke and the neurological adverse effects of atherosclerosis. Various techniques for vessel wall imaging have been developed and introduced to differentiate and analyze atherosclerotic plaques in the cervical carotid artery. High-resolution magnetic resonance imaging (HR-MRI) is the most important and popular vessel wall imaging technique for directly evaluating the vascular wall and intracranial artery disease. Intracranial artery atherosclerosis, dissection, moyamoya disease, vasculitis, and reversible cerebral vasoconstriction syndrome can also be diagnosed and differentiated by using HR-MRI. Here, we review the radiologic features of intracranial artery disease and cervical carotid artery atherosclerosis on HR-MRI and various other vessel wall imaging techniques (e.g., ultrasound, computed tomography, magnetic resonance, and positron emission tomography-computed tomography).
Arteries ; Atherosclerosis ; Carotid Arteries* ; Early Diagnosis ; Electrons ; Magnetic Resonance Imaging ; Moyamoya Disease ; Phenobarbital ; Plaque, Atherosclerotic ; Stroke ; Ultrasonography ; Vasculitis ; Vasoconstriction

An application of the multi-detector computed tomography (MDCT) for cardiac imaging is the non-invasive CT angiographic assessment of the cardiac morphology and the coronary arteries. The most important application is for the non-invasive diagnosis of coronary artery disease, and this includes assessment of coronary artery anomaly and stenosis, the evaluation of non-calcified atherosclerotic plaque and the follow-up examinations after stent deployment and bypass surgery. In the study, we have illustrated a variety of diseases of the coronay artery by using MDCT. These may facilitate the understanding of MDCT features of coronary artery lesions.
Arteries ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Follow-Up Studies ; Multidetector Computed Tomography* ; Plaque, Atherosclerotic ; Stents

BACKGROUNDNoninvasive detection of vulnerable plaque has a significant implication for prevention and treatment of atherosclerotic diseases. The aim of this study is to investigate the difference between vulnerable plaques and stable plaques in magnetic resonance (MR) images.

METHODSAtherosclerosis was induced in twenty male New Zealand white rabbits by high cholesterol diet and balloon injury of the abdominal aorta. After baseline (pre-triggering) MR imaging (MRI) scan, the rabbits underwent pharmaceutical triggering with Russell's viper venom and histamine to induce atherothrombosis, followed by another MRI scan 48 hours later (post-triggering). Rabbits were euthanized to obtain pathological and histological data. The results of MRI were compared with those of pathology and histology.

RESULTSMRI showed that abdominal aorta of the rabbits had pathological change of atherosclerosis in different degrees. Seventy-five plaques were analysed, among which 14 had vulnerable thrombi and 61 stable. Thrombosis was identified in 7 of 11 rabbits by post-triggering MRI, the sensitivity and K value of MR in detection of vulnerable plaque was 71% and 0.803 (P < 0.05). MRI data significantly correlated with the histopathological data in fibrous cap thickness (r = 0.749) plaque area (r = 0.853), lipid core area (r = 0.900). Compared with stable plaques, vulnerable plaques had a significantly thinner fibrous cap ((0.58 ± 0.27) mm vs. (0.95 ± 0.22) mm), larger lipid core area ((7.56 ± 2.78) mm(2) vs. (3.29 ± 1.75) mm(2)), and a higher ratio of lipid core area/plaque area ((55 ± 16)% vs. (27 ± 17)%), but plaque area was comparable in two groups on MRI. The ratio of lipid core area/plaque area was a strong predictor of vulnerable plaques.

CONCLUSIONMRI could distinguish vulnerable plaques from stable plaques in a rabbit model of atherothrombosis and may thus be useful as a noninvasive modality for detection of vulnerable plaques in humans.

Animals ; Aorta, Abdominal ; pathology ; Disease Models, Animal ; Magnetic Resonance Imaging ; methods ; Male ; Plaque, Atherosclerotic ; pathology ; Rabbits ; Thrombosis ; diagnosis

We describe aortic arch endarterectomy performed concomitantly with on-pump cardiac surgery in 2 patients with grade V arch atherosclerosis. In both patients, transesophageal echocardiographic findings led to the diagnosis of severe arch atherosclerosis associated with a mobile atheromatous plaque in the aortic arch. The severe arch atherosclerosis was managed with endarterectomy under deep hypothermic circulatory arrest. In patients with severe grade V atherosclerosis in the aortic arch, performing endarterectomy simultaneously with primary cardiac surgery may be justified as a way to reduce the risk of peripheral embolism, including cerebrovascular accidents, with minimal additional surgical risk.
Aorta ; Aorta, Thoracic ; Atherosclerosis ; Circulatory Arrest, Deep Hypothermia Induced ; Diagnosis ; Echocardiography ; Embolism ; Endarterectomy ; Humans ; Plaque, Atherosclerotic ; Stroke ; Thoracic Surgery

BACKGROUND: Asymptomatic coronary artery stenosis (ACAS) ≥50% is common in patients with acute ischemic cerebrovascular disease (AICVD), which portends a poor cardiovascular and cerebrovascular prognosis. Identifying ACAS ≥50% early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients. This study aimed to investigate whether aortic arch plaque (AAP), an early atherosclerotic manifestation of brain blood-supplying arteries, could be a predictor for ACAS ≥50% in AICVD. METHODS: In this cross-sectional study, atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography (CTA) in AICVD patients without coronary artery disease history. The patients were divided into ACAS ≥50% and non-ACAS ≥50% groups according to whether CTA showed stenosis ≥50% in at least one coronary arterial segment. The AAP characteristics of CTA were depicted from aspects of thickness, extent, and complexity. RESULTS: Among 118 analyzed patients with AICVD, 29/118 (24.6%) patients had ACAS ≥50%, while AAPs were observed in 86/118 (72.9%) patients. Increased AAP thickness per millimeter (adjusted odds ratio [OR]: 1.56, 95% confidence interval [CI]: 1.18-2.05), severe-extent AAP (adjusted OR: 13.66, 95% CI: 2.33-80.15), and presence of complex AAP (adjusted OR: 7.27, 95% CI: 2.30-23.03) were associated with ACAS ≥50% among patients with AICVD, independently of clinical demographics and cervicocephalic atherosclerotic stenosis. The combination of AAP thickness, extent, and complexity predicted ACAS ≥50% with an area under the receiver-operating characteristic curve of 0.78 (95% CI: 0.70-0.85, P < 0.001). All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS ≥50% in AICVD (all P < 0.05). CONCLUSIONS Thicker, severe-extent, and complex AAP were significant markers of the concomitant ACAS ≥50% in AICVD, possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis. As an integral part of atherosclerosis of brain blood-supplying arteries, AAP should not be overlooked in predicting ACAS ≥50% for patients with AICVD.
Aged ; Aorta, Thoracic ; pathology ; Cerebrovascular Disorders ; diagnosis ; Coronary Stenosis ; diagnosis ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Plaque, Atherosclerotic ; diagnosis ; Risk Factors