Kassem Mohamed, Florea Alexandru, Mottaghy Felix M, van Oostenbrugge Robert, Kooi M Eline
CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
Ann Transl Med. 2020 Oct;8(19):1266. doi: 10.21037/atm-2020-cass-16.
Rupture of a vulnerable carotid plaque is one of the leading causes of stroke. Carotid magnetic resonance imaging (MRI) is able to visualize all the main hallmarks of plaque vulnerability. Various MRI sequences have been developed in the last two decades to quantify carotid plaque burden and composition. Often, a combination of multiple sequences is used. These MRI techniques have been extensively validated with histological analysis of carotid endarterectomy specimens. High agreement between the MRI and histological measures of plaque burden, intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), fibrous cap (FC) status, inflammation and neovascularization has been demonstrated. Novel MRI sequences allow to generate three-dimensional isotropic images with a large longitudinal coverage. Other new sequences can acquire multiple contrasts using a single sequence leading to a tremendous reduction in scan time. IPH can be easily identified as a hyperintense signal in the bulk of the plaque on strongly T-weighted images, such as magnetization-prepared rapid acquisition gradient echo images, acquired within a few minutes with a standard neurovascular coil. Carotid MRI can also be used to evaluate treatment effects. Several meta-analyses have demonstrated a strong predictive value of IPH, LRNC, thinning or rupture of the FC for ischemic cerebrovascular events. Recently, in a large meta-analysis based on individual patient data of asymptomatic and symptomatic individuals with carotid artery stenosis, it was shown that IPH on MRI is an independent risk predictor for stroke, stronger than any known clinical risk parameter. Expert recommendations on carotid plaque MRI protocols have recently been described in a white paper. The present review provides an overview of the current status and applications of carotid plaque MR imaging and its future potential in daily clinical practice.
易损性颈动脉斑块破裂是中风的主要原因之一。颈动脉磁共振成像（MRI）能够显示斑块易损性的所有主要特征。在过去二十年中，已开发出各种MRI序列来量化颈动脉斑块负荷和成分。通常会使用多个序列的组合。这些MRI技术已通过颈动脉内膜切除术标本的组织学分析得到广泛验证。MRI与斑块负荷、斑块内出血（IPH）、富含脂质的坏死核心（LRNC）、纤维帽（FC）状态、炎症和新生血管形成的组织学测量之间具有高度一致性。新型MRI序列能够生成具有大纵向覆盖范围的三维各向同性图像。其他新序列可以使用单个序列获取多个对比度，从而大幅减少扫描时间。在强T加权图像上，如使用标准神经血管线圈在几分钟内采集的磁化准备快速采集梯度回波图像，IPH在大部分斑块中可轻易识别为高强度信号。颈动脉MRI还可用于评估治疗效果。多项荟萃分析表明，IPH、LRNC、FC变薄或破裂对缺血性脑血管事件具有很强的预测价值。最近，在一项基于无症状和有症状颈动脉狭窄个体的个体患者数据的大型荟萃分析中表明，MRI上的IPH是中风的独立风险预测因子，比任何已知的临床风险参数都更强。最近在一篇白皮书中描述了关于颈动脉斑块MRI方案的专家建议。本综述概述了颈动脉斑块MR成像的现状和应用及其在日常临床实践中的未来潜力。
