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Ultrasmall paramagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) imaging is a promising noninvasive method to identify high-risk atheromatous plaques. Iron oxide particles function as contrast-enhancing agents by creating a large dipolar magnetic field gradient that acts on the water molecules that diffuse close to the particles. Howarth reported that USPIO appeared to show a dual contrast effect with signal enhancement being seen in plaques with little inflammation and large fibrous caps. The contralateral side of symptomatic patients given USPIO were also analyzed. It was found that 95% patients showed bilateral USPIO uptake suggesting an inflammatory burden within their carotid atheroma bilaterally. Three different approaches have been adopted to make the seemly impossible task a reality: ultrashort echo times (uTE), inversion recovery on-resonance water suppression (IRON) imaging, and Gradient echo acquisition for superparamagnetic particles with positive contrast (GRASP).
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