Carotid Plaque Characterization Using Dual-Energy Computed Tomography: Predicting Imminent Ipsilateral Ischemic...

Area of Science:

• Radiology
• Neurology
• Cardiovascular Medicine

Background:

• Current clinical guidelines lack plaque imaging criteria for carotid endarterectomy decisions.
• Noninvasive imaging of carotid plaque morphology has advanced but isn't clinically applied for surgical risk assessment.

Purpose of the Study:

• To assess dual-energy computed tomography (DECT) plaque characteristics for differentiating stable from unstable carotid plaques.
• To evaluate DECT's ability to predict ipsilateral ischemic stroke within 30 days.

Main Methods:

• Retrospective case-controlled study of 1185 neck CT angiograms.
• Identified 14 patients with acute ischemic stroke due to plaque rupture and 42 matched controls.
• Developed and validated a predictive model using logistic regression.

Main Results:

• Plaque thickness, stenosis, ulceration, and intraplaque hemorrhage were associated with stroke risk.
• Patent luminal diameter and maximal external diameter showed inverse association.
• The predictive model achieved 82% overall accuracy, with high specificity (84%) and NPV (90%).

Conclusions:

• DECT imaging features of carotid plaque can predict subsequent ipsilateral ischemic stroke.
• DECT may assist in managing patients with vulnerable carotid plaques.