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Imaging of the Carotid Artery

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Carotid Artery Disease

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Abstract

This chapter describes different methods for imaging the carotid artery in the clinical diagnosis of disease including the workup of potential stroke sources. We review carotid artery imaging by multiple techniques including digital subtraction angiography (DSA), computed tomography angiography (CTA), magnetic resonance angiography (MRA), and vessel wall MRI (vwMRI). The interpretation of each technique, advantages, and disadvantages are discussed. Imaging examples of each modality are also provided. This will serve as a primer for the interpretation of currently available diagnostic imaging techniques and will aid in surgical and interventional planning.

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References

  1. Croft RJ, Ellam LD, Harrison MJ. Accuracy of carotid angiography in the assessment of atheroma of the internal carotid artery. Lancet. 1980;1:997–1000.

    Article  CAS  PubMed  Google Scholar 

  2. Wardlaw JM, Chappell FM, Best JJ, Wartolowska K, Berry E, NHS Research and Development Health Technology Assessment Carotid Stenosis Imaging Group, et al. Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis. Lancet. 2006;367:1503–12.

    Article  CAS  PubMed  Google Scholar 

  3. North American symptomatic carotid endarterectomy trial. Methods, patient characteristics, and progress. Stroke. 1991;22:711–720.

    Google Scholar 

  4. Fox AJ. How to measure carotid stenosis. Radiology. 1993;186:316–8.

    Article  CAS  PubMed  Google Scholar 

  5. Manninen AL, Isokangas JM, Karttunen A, Siniluoto T, Nieminen MT. A comparison of radiation exposure between diagnostic cta and dsa examinations of cerebral and cervicocerebral vessels. AJNR Am J Neuroradiol. 2012;33:2038–42.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schminke U, Motsch L, Hilker L, Kessler C. Three-dimensional ultrasound observation of carotid artery plaque ulceration. Stroke. 2000;31:1651–5.

    Article  CAS  PubMed  Google Scholar 

  7. Anzidei M, Napoli A, Zaccagna F, Di Paolo P, Saba L, Cavallo Marincola B, et al. Diagnostic accuracy of colour doppler ultrasonography, ct angiography and blood-pool-enhanced mr angiography in assessing carotid stenosis: a comparative study with dsa in 170 patients. Radiol Med. 2012;117:54–71.

    Article  CAS  PubMed  Google Scholar 

  8. Bartlett ES, Walters TD, Symons SP, Fox AJ. Quantification of carotid stenosis on ct angiography. AJNR Am J Neuroradiol. 2006;27:13–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Bartlett ES, Walters TD, Symons SP, Aviv RI, Fox AJ. Classification of carotid stenosis by millimeter ct angiography measures: effects of prevalence and gender. AJNR Am J Neuroradiol. 2008;29:1677–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Fox AJ, Eliasziw M, Rothwell PM, Schmidt MH, Warlow CP, Barnett HJ. Identification, prognosis, and management of patients with carotid artery near occlusion. AJNR Am J Neuroradiol. 2005;26:2086–94.

    PubMed  PubMed Central  Google Scholar 

  11. Eesa M, Hill MD, Al-Khathaami A, Al-Zawahmah M, Sharma P, Menon BK, et al. Role of ct angiographic plaque morphologic characteristics in addition to stenosis in predicting the symptomatic side in carotid artery disease. AJNR Am J Neuroradiol. 2010;31:1254–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Nandalur KR, Baskurt E, Hagspiel KD, Phillips CD, Kramer CM. Calcified carotid atherosclerotic plaque is associated less with ischemic symptoms than is noncalcified plaque on mdct. AJR Am J Roentgenol. 2005;184:295–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Menon BK, Singh J, Al-Khataami A, Demchuk AM, Goyal M, Calgary CTA Study Group. The donut sign on ct angiography: an indicator of reversible intraluminal carotid thrombus? Neuroradiology. 2010;52:1055–6.

    Article  PubMed  Google Scholar 

  14. U-King-Im JM, Fox AJ, Aviv RI, Howard P, Yeung R, Moody AR, et al. Characterization of carotid plaque hemorrhage: a ct angiography and mr intraplaque hemorrhage study. Stroke. 2010;41:1623–9.

    Article  PubMed  Google Scholar 

  15. Eisenmenger LB, Aldred BW, Kim SE, Stoddard GJ, de Havenon A, Treiman GS, et al. Prediction of carotid intraplaque hemorrhage using adventitial calcification and plaque thickness on cta. AJNR Am J Neuroradiol. 2016;37:1496–503.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169:2078–86.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Poggi MM, Suh WW, Saltz L, Konski AA, Mohiuddin M, Herman J, et al. Acr appropriateness criteria on treatment of anal cancer. J Am Coll Radiol. 2007;4:448–56.

    Article  PubMed  Google Scholar 

  18. Mnyusiwalla A, Aviv RI, Symons SP. Radiation dose from multidetector row ct imaging for acute stroke. Neuroradiology. 2009;51:635–40.

    Article  PubMed  Google Scholar 

  19. Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.

    Article  CAS  PubMed  Google Scholar 

  20. Kim KP, Berrington de Gonzalez A, Pearce MS, Salotti JA, Parker L, McHugh K, et al. Development of a database of organ doses for paediatric and young adult ct scans in the United Kingdom. Radiat Prot Dosim. 2012;150:415–26.

    Article  CAS  Google Scholar 

  21. Boujan T, Neuberger U, Pfaff J, Nagel S, Herweh C, Bendszus M, et al. Value of contrast-enhanced mra versus time-of-flight mra in acute ischemic stroke mri. AJNR Am J Neuroradiol. 2018;39:1710–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. McNally JS, McLaughlin MS, Hinckley PJ, Treiman SM, Stoddard GJ, Parker DL, et al. Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke. Stroke. 2015;46:84–90.

    Article  PubMed  Google Scholar 

  23. McNally JS, Hinckley PJ, Sakata A, Eisenmenger LB, Kim SE, De Havenon AH, et al. Magnetic resonance imaging and clinical factors associated with ischemic stroke in patients suspected of cervical artery dissection. Stroke. 2018;49:2337–44.

    Article  PubMed  Google Scholar 

  24. Daemen MJ, Ferguson MS, Gijsen FJ, Hippe DS, Kooi ME, Demarco K, et al. Carotid plaque fissure: an underestimated source of intraplaque hemorrhage. Atherosclerosis. 2016;254:102–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Takaya N, Yuan C, Chu B, Saam T, Polissar NL, Jarvik GP, et al. Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation. 2005;111:2768–75.

    Article  PubMed  Google Scholar 

  26. Hosseini AA, Kandiyil N, Macsweeney ST, Altaf N, Auer DP. Carotid plaque hemorrhage on magnetic resonance imaging strongly predicts recurrent ischemia and stroke. Ann Neurol. 2013;73:774–84.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gupta A, Baradaran H, Schweitzer AD, Kamel H, Pandya A, Delgado D, et al. Carotid plaque mri and stroke risk: a systematic review and meta-analysis. Stroke. 2013;44:3071–7.

    Article  PubMed  Google Scholar 

  28. Saam T, Hetterich H, Hoffmann V, Yuan C, Dichgans M, Poppert H, et al. Meta-analysis and systematic review of the predictive value of carotid plaque hemorrhage on cerebrovascular events by magnetic resonance imaging. J Am Coll Cardiol. 2013;62:1081–91.

    Article  PubMed  Google Scholar 

  29. Yamada N, Higashi M, Otsubo R, Sakuma T, Oyama N, Tanaka R, et al. Association between signal hyperintensity on t1-weighted mr imaging of carotid plaques and ipsilateral ischemic events. AJNR Am J Neuroradiol. 2007;28:287–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. McNally JS, Yoon HC, Kim SE, Narra KK, McLaughlin MS, Parker DL, et al. Carotid mri detection of intraplaque hemorrhage at 3T and 1.5T. J Neuroimaging. 2015;25:390–6.

    Article  Google Scholar 

  31. Wang J, Bornert P, Zhao H, Hippe DS, Zhao X, Balu N, et al. Simultaneous noncontrast angiography and intraplaque hemorrhage (snap) imaging for carotid atherosclerotic disease evaluation. Magn Reson Med. 2013;69:337–45.

    Article  PubMed  Google Scholar 

  32. Ota H, Yarnykh VL, Ferguson MS, Underhill HR, Demarco JK, Zhu DC, et al. Carotid intraplaque hemorrhage imaging at 3.0-t mr imaging: comparison of the diagnostic performance of three t1-weighted sequences. Radiology. 2010;254:551–63.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Freilinger TM, Schindler A, Schmidt C, Grimm J, Cyran C, Schwarz F, et al. Prevalence of nonstenosing, complicated atherosclerotic plaques in cryptogenic stroke. J Am Coll Cardiol Img. 2012;5:397–405.

    Article  Google Scholar 

  34. Xu D, Hippe DS, Underhill HR, Oikawa-Wakayama M, Dong L, Yamada K, et al. Prediction of high-risk plaque development and plaque progression with the carotid atherosclerosis score. J Am Coll Cardiol Img. 2014;7:366–73.

    Article  Google Scholar 

  35. Ota H, Yu W, Underhill HR, Oikawa M, Dong L, Zhao X, et al. Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3t mri study. Arterioscler Thromb Vasc Biol. 2009;29:1696–701.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Trivedi RA, Jean-Marie U, Graves MJ, Horsley J, Goddard M, Kirkpatrick PJ, et al. Mri-derived measurements of fibrous-cap and lipid-core thickness: the potential for identifying vulnerable carotid plaques in vivo. Neuroradiology. 2004;46:738–43.

    Article  PubMed  Google Scholar 

  37. Cai J, Hatsukami TS, Ferguson MS, Kerwin WS, Saam T, Chu B, et al. In vivo quantitative measurement of intact fibrous cap and lipid-rich necrotic core size in atherosclerotic carotid plaque: comparison of high-resolution, contrast-enhanced magnetic resonance imaging and histology. Circulation. 2005;112:3437–44.

    Article  PubMed  Google Scholar 

  38. Wasserman BA, Smith WI, Trout HH 3rd, Cannon RO 3rd, Balaban RS, Arai AE. Carotid artery atherosclerosis: in vivo morphologic characterization with gadolinium-enhanced double-oblique mr imaging initial results. Radiology. 2002;223:566–73.

    Article  PubMed  Google Scholar 

  39. Yuan C, Zhang SX, Polissar NL, Echelard D, Ortiz G, Davis JW, et al. Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation. 2002;105:181–5.

    Article  PubMed  Google Scholar 

  40. Kerwin WS, Oikawa M, Yuan C, Jarvik GP, Hatsukami TS. Mr imaging of adventitial vasa vasorum in carotid atherosclerosis. Magn Reson Med. 2008;59:507–14.

    Article  CAS  PubMed  Google Scholar 

  41. Kerwin WS, O’Brien KD, Ferguson MS, Polissar N, Hatsukami TS, Yuan C. Inflammation in carotid atherosclerotic plaque: a dynamic contrast-enhanced mr imaging study. Radiology. 2006;241:459–68.

    Article  PubMed  Google Scholar 

  42. Mendes J, Parker DL, McNally S, DiBella E, Bolster BD Jr, Treiman GS. Three-dimensional dynamic contrast enhanced imaging of the carotid artery with direct arterial input function measurement. Magn Reson Med. 2014;72:816–22.

    Article  CAS  PubMed  Google Scholar 

  43. Sun J, Song Y, Chen H, Kerwin WS, Hippe DS, Dong L, et al. Adventitial perfusion and intraplaque hemorrhage: a dynamic contrast-enhanced mri study in the carotid artery. Stroke. 2013;44:1031–6.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Dong L, Kerwin WS, Chen H, Chu B, Underhill HR, Neradilek MB, et al. Carotid artery atherosclerosis: effect of intensive lipid therapy on the vasa vasorum–evaluation by using dynamic contrast-enhanced mr imaging. Radiology. 2011;260:224–31.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Utah Health System, Salt Lake City, UT, USA

    Michael McLaughlin & J. Scott McNally

Authors
  1. Michael McLaughlin
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  2. J. Scott McNally
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Corresponding author

Correspondence to J. Scott McNally .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    Min S. Park

  2. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA

    M. Yashar S. Kalani

  3. Department of Neurology, University of Utah, Salt Lake City, UT, USA

    Adam de Havenon

  4. Department of Radiology, University of Utah, Salt Lake City, UT, USA

    J. Scott McNally

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McLaughlin, M., McNally, J.S. (2020). Imaging of the Carotid Artery. In: Park, M., Kalani, M., de Havenon, A., McNally, J. (eds) Carotid Artery Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-41138-1_3

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  • DOI: https://doi.org/10.1007/978-3-030-41138-1_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-41137-4

  • Online ISBN: 978-3-030-41138-1

  • eBook Packages: MedicineMedicine (R0)

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