Lipid-rich necrotic core
Currently, MRI is the gold standard in carotid plaque imaging, with its high resolution and high sensitivity for identifying intraplaque hemorrhage (IPH), ulceration, lipid-rich necrotic core (LRNC), and inflammation. However, MRI is limited due to time constraints.
Identification of carotid non-hemorrhagic lipid-rich necrotic core by magnetization-prepared rapid acquisition gradient-echo imaging: Validation by contrast-enhanced T1 weighted imaging 1).
CT also allows for high-resolution imaging and can accurately detect ulceration and calcification, but cannot reliably differentiate LRNC from IPH.
PET/CT is an effective technique to identify active inflammation within the plaque, but it does not allow for assessment of anatomy, ulceration, IPH, or LRNC.
Ultrasonography, with the aid of contrast enhancement, is a cost-effective technique to assess plaque morphology and characteristics, but it is limited in sensitivity and specificity for detecting LRNC, plaque hemorrhage, and ulceration compared with MRI.
US can detect congenital variants, dissection, stenosis, and vasculopathy. In addition, correlation of US findings with both magnetic resonance imaging and computed tomography more comprehensively demonstrates the complementary nature of these imaging modalities 2).