Evaluation of Carotid Plaque Vulnerability Using Dual-energy Computed Tomography Angiography: a Prospective...

Area of Science:

• Medical Imaging
• Cardiovascular Imaging
• Radiology

Background:

• Carotid plaque vulnerability is a key determinant of stroke risk.
• Accurate assessment of plaque characteristics is crucial for guiding treatment decisions.
• Current imaging modalities have limitations in fully characterizing plaque vulnerability.

Purpose of the Study:

• To evaluate the effectiveness of dual-energy computed tomography (DECT) in assessing carotid plaque vulnerability.
• To determine if DECT parameters can differentiate between symptomatic and asymptomatic carotid plaques.

Main Methods:

• A prospective observational study included 46 patients undergoing DECT for carotid plaque evaluation before stenting.
• DECT parameters (Z, Rho, VNC, FF, IC) and MRI-derived relative signal intensity (rSI) were measured.
• Statistical analyses, including logistic regression and ROC analysis, were performed to assess associations and diagnostic performance.

Main Results:

• Symptomatic plaques showed significantly lower Rho and VNC, and higher fat fraction (FF) compared to asymptomatic plaques.
• DECT-derived FF was significantly associated with symptomatic lesions, independent of rSI and VNC.
• Adding FF to rSI improved the discrimination of symptomatic plaques (AUC 0.792 vs 0.560).

Conclusions:

• DECT-derived fat fraction (FF) is a potential imaging biomarker for carotid plaque vulnerability.
• DECT offers complementary information to MRI for evaluating plaque characteristics in patients with carotid artery stenosis.
• Further research is warranted to validate DECT's role in clinical practice for stroke prevention.