Imaging of the High Risk Carotid Plaque: Magnetic Resonance Imaging (MRI)

Abstract The emergence of the concept of high-risk atherosclerotic plaque has led to considerable interest in non-invasive imaging techniques to identify high-risk features prior to clinical sequelae. For plaques in the carotid arteries, magnetic resonance imaging (MRI) has undergone considerable histological validation to link imaging features to indicators of plaque instability including plaque burden, intraplaque hemorrhage, fibrous cap disruption, lipid rich necrotic core, and calcification. Recently introduced imaging technologies, especially those focused on three-dimensional imaging sequences, are now poised for integration into the clinical workup of patients with suspected carotid atherosclerosis. The purpose of this article is to review the carotid plaque MRI techniques that are most ready for integration into the clinic.