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Developments in both magnetic resonance imaging (MRI) technology, computer software and a huge array of potential cellular and molecular targets are a step toward the identification of high-risk carotid disease. This chapter covers the recent advances with particular respect to MRI. The carotid artery plaque is ideally suited for imaging by multicontrast MRI. The chapter discusses a variety of molecular targets that may provide improved imaging of carotid atherosclerotic plaque using MRI. The presence of neovessels is strongly associated with plaque inflammation and likelihood of rupture, presumably by allowing an alternative route for entry of monocytes and lymphocytes into the plaque. Histological studies have demonstrated that superficial thrombus superimposed on a ruptured atherosclerotic plaque characterizes those plaques at high risk of ischemic events. The chapter describes the role of matrix metalloproteinases (MMPs) in plaque instability and matrix remodeling in atherosclerotic plaques.
An atherosclerotic plaque with specific morphological features is more prone to rupture, and irregular luminal plaque surfaces are more prone to thrombus formation, thromboembolization and consequent acute events. Since computerized tomography angiography (CTA) can accurately grade the severity of carotid luminal stenosis, computerized tomography (CT) is increasingly used in the evaluation of stroke patients. CTA had a high degree of correlation with results of digital subtraction angiography (DSA) in the evaluation of carotid luminal stenosis. The main advantage of multidetector CT (MDCT) for carotid atherosclerotic plaque evaluation is the increased in-plane resolution, the decreased slice thickness and the subsequent ability to obtain near isotropic voxels. In MDCT the reconstructed slice thickness is independent of the detector collimation and is equal to or larger than the single detector collimation. MDCT can assess luminal surface morphology with the same or better accuracy than DSA.
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