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Luminal irregularity in the internal carotid artery is demonstrated on both a nonenhanced hybrid of pseudocontinuous and pulsed arterial spin-labeling (arrow, A) and CE-MRA (C) images, but it is not seen on the 3D TOF image (dashed arrow, B). hASL indicates hybrid of pseudocontinuous and pulsed ASL. The figure is reproduced with permission from Koktzoglou et al. 63
Source publication
Atherosclerosis remains the leading cause of long term mortality and morbidity worldwide, despite significant advancement in its management. Vulnerable atherosclerotic plaques are principally responsible for thromboembolic events in various arterial territories such as carotid, coronary and lower limb vessels. Carotid plaque ulceration is one of th...
Context in source publication
Context 1
... methods have demonstrated the ability to image arteries of the head and neck without signal from static background. 62,63 In particular, a hybrid of pseudocontinuous and pulsed arterial spin-labeling with a fast low-angle shot readout has shown similar results in detecting carotid luminal irregularity with contrast-enhanced MRA (CE-MRA) and overcomes some of the limitations of TOF-MRA (Fig 6). 63 The inversion recovery-based methods 64 and the quiescent interval low-angle shot method 65 use in- plane saturation pulses to suppress the background signal, al- lowing only the nonsaturated inflowing blood to be imaged. ...
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Atherosclerosis remains the leading cause of long-term mortality and morbidity worldwide, despite remarkable advancement in its management. Vulnerable atherosclerotic plaques are principally responsible for thromboembolic events in various arterial territories such as carotid, coronary, and lower limb vessels. Carotid plaque ulceration is one of th...
Citations
... Duplex ultrasound is the first-line imaging tool for the assessment of carotid diseases (14). The use of 3D ultrasound for quantification of vascular disease can provide more information on plaque morphology and degree of stenosis (15,16) and is capable of accurately assessing changes in plaque volume in response to antiatherosclerotic therapies and determining stroke risk stratification (17,18). Tomographic 3DUS (t3DUS) is a novel free-hand electromagnetically tracked system that can be coupled to an ultrasound system and used for offline analysis with respect to measuring a number of parameters, including arterial lumen diameter and length, wall volume and percentage of maximum stenosis (19,20), with only one study investigating the accuracy of t3DUS for measuring CPV (21). ...
Background
Tomographic 3D ultrasound (t3DUS) is a promise imaging technique for quantifying carotid plaque through measuring the degree of stenosis and plaque volume. Carotid plaque volume (CPV) could add benefit in predicting the potential risk of stroke.
Purpose
To assess the reproducibility and accuracy of t3DUS for measuring CPV within the internal carotid artery in patients undergoing carotid endarterectomy.
Material and Methods
t3DUS was used to obtain CPV in vivo from 25 symptomatic patients prior to surgery. Ex vivo CPV from the carotid endarterectomy specimen was then measured using a validated saline displacement method as a reference standard. CPV for each patient was measured twice using both methods (total n = 50 per technique). Intraclass correlation coefficient (ICC) and Bland–Altman plot were used to establish bias and limit of agreement between CPV measurements.
Results
There was an excellent agreement between t3DUS and reference test with respect to measuring CPV with an ICC value of 0.98 (95% confidence interval = 0.97–0.99, P < 0.001). Bias in measurements was 0.02 ± 0.11 cm ³ (95% limit of agreement = −0.19 to 0.25). Intra-observer agreement of t3DUS CPV measurements was excellent with an ICC value of 0.95 (95% confidence interval = 0.92–0.97, P < 0.001). Bias in measurements was 0.004 ± 0.07 cm ³ (95% limit of agreement = −0.14 to 0.15).
Conclusion
t3DUS is a reproducible imaging method and showed excellent agreement with the reference standard with respect to measuring CPV. These findings suggest that t3DUS has the potential to be a valuable non-invasive tool for assessing carotid plaque burden and predicting the risk of stroke.
... 26,27 A prospective cohort study of 43 patients from the ORION trial with 16% to 79% carotid stenosis who underwent carotid MRA and US demonstrated significant inter-modality plaque thickness measurement agreement (Pearson correlation coefficient r 5 0.93; P < 0.001). 28 However, when US imaging is limited, 29 CTA or MRA can appropriately evaluate plaque characteristics. 16 The carotid plaque area and volume are highly reproducible parameters associated with plaque size. ...
Stroke represents a major cause of morbidity and mortality worldwide with carotid atherosclerosis responsible for a large proportion of ischemic strokes. Given the high burden of the disease , early diagnosis and optimal secondary prevention are essential elements in clinical practice. For a long time, the degree of stenosis had been considered the parameter to judge the severity of carotid atherosclerosis. Over the last 30 years, literature has shifted attention from stenosis to structural characteristics of atherosclerotic lesion, eventually leading to the "vulnerable plaque" model. These "vulnerable plaques" frequently demonstrate high-risk imaging features that can be assessed by various non-invasive imaging modalities.
To access CPD test for this article click here: https://www.sonographers.org/cpds/An_unusual_case_of_bilateral_internal_carotid_artery_occlusion
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