Baradaran Hediyeh, Gupta Ajay
Department of Radiology, University of Utah, Salt Lake City, UT, USA.
Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
Ann Transl Med. 2020 Oct;8(19):1277. doi: 10.21037/atm-20-1939.
Extracranial carotid artery atherosclerotic disease is a major contributor to ischemic stroke. Carotid atherosclerotic disease can present with a spectrum of findings ranging from mild carotid intima-media thickness to high-risk vulnerable carotid plaque features and carotid stenosis. Before leading to clinically overt stroke or transient ischemic attack, there may be other markers of downstream ischemia secondary to carotid atherosclerotic disease. In this review article, we will review some of the imaging findings that may be seen downstream to carotid artery disease on various imaging modalities, including hemodynamic and perfusional abnormalities which may be seen on CT, MR, or using other advanced imaging techniques, white matter hyperintensities on brain imaging, silent or covert brain infarctions, cerebral microbleeds, and regional and generalized cerebral volume loss. Many of these imaging findings are seen routinely on brain magnetic resonance imaging in patients without overt clinical symptoms. Despite frequently being asymptomatic, many of these imaging findings are also strongly associated with increased risk of future stroke, cognitive impairment, and even mortality. We will review the existing evidence underpinning the associations between these frequently encountered imaging findings and carotid artery atherosclerotic disease. Future validation of these imaging findings could lead to them being powerful biomarkers of cerebrovascular health.
颅外颈动脉粥样硬化疾病是缺血性卒中的主要原因。颈动脉粥样硬化疾病可表现出一系列表现，从轻度颈动脉内膜中层厚度到高危易损颈动脉斑块特征及颈动脉狭窄。在导致临床明显的卒中或短暂性脑缺血发作之前，可能存在继发于颈动脉粥样硬化疾病的下游缺血的其他标志物。在这篇综述文章中，我们将回顾在各种成像模态下可能在颈动脉疾病下游看到的一些影像学表现，包括在CT、MR上或使用其他先进成像技术可能看到的血流动力学和灌注异常、脑成像上的白质高信号、无症状或隐匿性脑梗死、脑微出血以及局部和全身性脑容量减少。许多这些影像学表现在无明显临床症状的患者的脑磁共振成像中经常可见。尽管这些影像学表现很多时候无症状，但它们中的许多也与未来卒中、认知障碍甚至死亡风险增加密切相关。我们将回顾支持这些常见影像学表现与颈动脉粥样硬化疾病之间关联的现有证据。这些影像学表现的未来验证可能会使其成为脑血管健康的有力生物标志物。
