Visualization of the Ruptured Plaque by Magnetic Resonance Imaging
A 61-year-old man at risk of generalized arteriosclerosis due to heavy long-term smoking (60 pack-years) but no other risk factors was enrolled in a research study of atherosclerosis by noninvasive vascular MRI. The patient reported an episode of amaurosis fugax of the right eye 4 months before the scan but had no other clinical symptoms.
MRI of the neck vessels revealed a pronounced bilateral increase in wall thickness of internal carotid arteries as well as of the common carotid and vertebral arteries on both sides (Figure 1A and 1B). Immediately below the carotid bifurcation, the right common carotid artery showed significant thickening of the vessel wall with an appearance consistent with two atherosclerotic plaques (Figure 1B). On enlargement of the region of interest, both plaques showed a dark, lipid-rich core covered by a thin fibrous cap (Figure 1C). One lesion was suggestive of a ruptured plaque showing discontinuity of the fibrous cap (arrow). However, there was no evidence of significant luminal narrowing.
Vascular ultrasound confirmed these findings with evidence of irregular atheroma around the carotid bifurcation (Figure 2). Bilateral Doppler recordings displayed velocities within normal range.
This case likely represents a ruptured carotid plaque leading to an episode of amaurosis fugax.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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