Cardiac Magnetic Resonance Features of the Disruption-Prone and the Disrupted Carotid Plaque

Stroke is a leading cause of long-term disability and is the third most common cause of death in the U.S. and western countries. Twenty percent of strokes are thought to arise from the carotid artery. Histopathological studies have suggested that plaque disruption is a key factor in the etiology of carotid-related ischemic events. Features associated with plaque disruption include intraplaque hemorrhage, large necrotic cores with thin overlying fibrous caps, plaque neovasculature, and inflammatory cell infiltrate. In vivo high-spatial-resolution, multicontrast-weighted cardiac magnetic resonance (CMR) has been extensively evaluated using histology as the gold standard, and has documented reliability in the identification of these key carotid plaque features. This pictorial essay illustrates the capability of CMR for identifying features of disruption-prone and disrupted atherosclerotic carotid plaques.