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Atherosclerotic carotid stenosis (CS) comprises about 20% of all cerebral infarctions in Western countries, and the number of patients with CS is also likely to increase in Japan due to changes in dietary habits and the unprecedented rate of the aging population. Therefore, the significance of appropriate management of CS will also concomitantly increase. The risk of future ischemic events in patients with CS has long been assessed mainly by luminal morphology as angiographically determined stenosis and ulceration. However, recent remarkable advances in vessel wall visualization using ultrasound and magnetic resonance imaging (MRI) combined with a deeper understanding of vascular biology have shown that vessel wall characteristics also have considerable influence on the onset of ischemic events. Assessments of plaque characteristics are now important in the management of CS. Several features of a vulnerable plaque such as intraplaque hemorrhage, large lipid-rich necrotic cores, and ruptured fibrous caps have been precisely demonstrated using MRI. The current status of carotid plaque characterization using MRI will be briefly outlined in this review. Thereafter, the potential clinical implications and future challenges of analyzing plaque using MRI will be discussed.

MRI Characterization of Atherosclerotic Carotid Plaque