DeMarco JK, guest ed. Mukherji S, consulting ed. Plaque Imaging. Elsevier, February 2016. Neuroimaging Clinics of North America; vol. 36; no. 1; pgs. 1–186; $360.00
The February 2016 issue of the Neuroimaging Clinics of North America, edited by Dr. J. Kevin DeMarco, includes contributions from 30 authors for a total of 13 articles dealing with both the present and future state of plaque imaging. The emphasis is centered on how radiologic evaluation of carotid plaque should not focus solely on quantifying stenoses. Rather, a more thorough and useful evaluation entails identification of specific plaque characteristics that have implications with regards to plaque instability/vulnerability, patient cardiovascular risk stratification, patient adverse outcomes, and monitoring/measuring response to treatment in all patients along the spectrum of atherosclerotic disease, from those with low-grade or asymptomatic disease to those with high-grade stenosis.
There is significant overlap in the material presented, particularly with regard to identification of concerning plaque features including but not limited to a lipid rich necrotic core, intraplaque hemorrhage, fibrous cap, neovascularity, and inflammation. Though redundant, this helps to reinforce the key imaging features and their clinical implications. The majority of the articles focus on MRI imaging followed by ultrasound and PET scan. CT evaluation of plaque is only briefly mentioned at times only to provide a broader context of the current state of imaging. The article “Three-Dimensional Carotid Plaque MR Imaging” provides a nice, albeit brief, introduction to the various 3D imaging sequences and techniques available to better assess plaque structure and composition, which are detailed in the subsequent article “Analysis of Multicontrast Carotid Plaque MR Imaging”. The article “Unusual Cerebral Emboli”, though interesting and of import, felt somewhat out of place given that it didn’t further education on carotid plaque imaging. Several articles, specifically the final two, “Plaque Imaging to Decide on Optimal Treatment: Medical Versus Carotid Endarterectomy Versus Carotid Artery Stenting” and “Clinical Perspective of Carotid Plaque Imaging”, focus more on the effects imaging may have on clinical decision making.
Provided images are plentiful, with most clearly annotated and effectively highlighting the capabilities of the various imaging modalities and the corresponding key morphologic and biologic plaque features. The references are comprehensive and current, the latter in large part related to the application of newer technologies and concepts.
The value of this book lies in the potential to impact radiologic evaluation and clinical management, as well as patient outcomes. As greater emphasis in healthcare is placed on preventative medicine, being able to correctly identify at-risk patients and allow for both appropriate and timely intervention will be paramount not only to improving patient morbidity and mortality but also to decreasing the associated economic burden. This volume is excellent for neuroradiologists as well as any diagnostic radiologist under whose purview sonographic and nuclear medicine vascular evaluation may fall. Neurointerventionalists, vascular surgeons, and vascular neurologists would also benefit from familiarizing themselves with the complete plaque profile we are able to identify and the tests available by which we can perform that evaluation, as these in turn may help guide treatment.
