High-Risk Plaque Features in the Non-stenosing Carotid Artery, How Frequently is This Reported? A Retrospective Study

Area of Science:

• Neuroimaging
• Vascular Neurology
• Cardiovascular Research

Background:

• Non-stenosing carotid plaques (<50%) may cause embolic stroke of undetermined source (ESUS).
• Morphological high-risk features of these plaques are often not described in neuroradiology reports due to lack of significant stenosis.
• Accurate identification of these features is crucial for stroke risk stratification.

Purpose of the Study:

• To determine the frequency of reporting high-risk features in non-stenosing carotid plaques within diagnostic imaging reports.
• To assess the discrepancy between identified plaque features and their documentation in computed tomography angiography (CTA) reports.

Main Methods:

• Retrospective analysis of 152 computed tomography angiography (CTA) reports from a previously published cohort.
• Calculation of plaque feature reporting frequencies (thickness, ulceration, length, soft component, calcification).
• Comparison of reporting frequencies for specific high-risk plaque features identified in CTA imaging results using Fisher exact test.

Main Results:

• Reporting frequency for plaque thickness was 0% (0/40), ulceration 8.1% (3/37), and length 24.1% (7/29).
• In contrast, plaque calcification was reported in 100% (122/122) and soft component in 72.1% (31/34) of cases where present.
• These differences in reporting frequencies were statistically significant (all P < 0.001).

Conclusions:

• Neuroradiology reports frequently omit high-risk carotid plaque characteristics when stenosis is not hemodynamically significant.
• There is a need for improved reporting standards and collaboration between neuroradiologists and neurologists.
• Development of algorithms and scoring systems is recommended to better identify embolic-risk plaque features.