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Cervical Carotid Plaque MRI

Review of Atherosclerosis Imaging Features and their Histologic Underpinnings

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Abstract

Magnetic resonance (MR) imaging is considered the gold standard for non-invasive evaluation of carotid artery plaque morphology and composition. A number of studies have demonstrated the clinical utility of MR plaque imaging in the risk stratification of carotid atherosclerotic disease, determination of stroke etiology, and identification of surgical and endovascular candidates for carotid revascularization procedures. The MR plaque imaging also provides researchers and clinicians with valuable insights into the pathogenesis, natural history and composition of carotid atherosclerotic disease. Nevertheless, the field of MR plaque imaging is complex, and requires a thorough knowledge of the histologic basis for how various plaque features appear on imaging. This article details the pathogenesis and histology of atherosclerosis, reviews the expected appearance of different plaque components, and describes how MR imaging features may be related to symptomatology or predict future ischemic events.

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Acknowledgements

The authors would like to thank Dr. Sonia Watson (Mayo Clinic, Rochester) for editing the manuscript.

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Authors and Affiliations

  1. Department of Neuroradiology, Mayo Clinic, 723 6th St. SW, 55902, Rochester, MN, USA

    John C. Benson, John Huston III & Waleed Brinjikji

  2. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA

    Heidi Cheek & Marie C. Aubry

  3. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Giuseppe Lanzino

  4. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Alejandro Rabinstein

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Contributions

John C. Benson, MD: Writing original draft, editing final draft, collecting images; Heidi Cheek, MHA, PA: Collecting and reviewing pathology slides; Marie C. Aubry, MD: Collecting and reviewing pathology slides; Giuseppe Lanzino, MD: Supervision, editing final draft, conceptualization; John Huston III, MD: Editing final draft, conceptualization; Alejandro Rabinstein, MD: Editing final draft, conceptualization; Waleed Brinjikji, MD: Conceptualization, writing original draft, editing final draft

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Correspondence to John C. Benson.

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Conflict of interest

J.C. Benson, H. Cheek, M. C. Aubry, G. Lanzino, J. Huston III, A. Rabinstein and W. Brinjikji declare that they have no competing interests.

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All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Benson, J.C., Cheek, H., Aubry, M.C. et al. Cervical Carotid Plaque MRI. Clin Neuroradiol 31, 295–306 (2021). https://doi.org/10.1007/s00062-020-00987-y

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