Detection of Carotid Atherosclerotic Plaque Ulceration, Calcification, and Thrombosis by Multicontrast Weighted Magnetic Resonance Imaging
A 62-year-old man presented to the emergency department with a chief complaint of severe headache and decreased vision in his left eye. Initial physical examination demonstrated a new-onset left homonymous hemianopsia, which warranted a stroke workup. The patient’s head CT was significant for a 2.3×3.7-cm acute hemorrhage in the right posterior parietal and occipital lobes. Conventional angiography was performed and interpreted as >90% stenosis of both internal carotid arteries without ulceration. The remainder of the work-up, including echocardiogram, was negative. An ensuing carotid magnetic resonance examination with a phased-array carotid coil and high-resolution (0.3×0.3 mm pixel size) multicontrast weighted sequences confirmed the stenosis and demonstrated ulceration and calcification in both carotids and mural thrombus formation in the left carotid (Figures 1 and 2⇓). After completely recovering from the stroke, the patient underwent staged bilateral carotid endarterectomy. Histological examination of the specimens confirmed the MRI findings of bilateral ulceration and left mural thrombus formation (Figure 3).
Dr Kliot is cofounder of a company, UltraImage Corp, which is now part of Pathway Medical Technologies and develops and makes MRI phase-array coils similar to those used in this article.