Table 1

Pros and cons of atherosclerotic plaque imaging modalities

ProsConsLuminal
definition
Arterial wall and plaqueSpatial resolutionHemodynamic information
DSA
  • Provides accurate visualization of the arterial lumen

  • Interventions such as angioplasty and stenting can be performed during DSA

  • Allows the assessment of real-time collaterals

  • Can assess fractional flow reserve

  • Invasive

  • Luminal modality unable to assess plaque burden

+++++++++++++++
CTA
  • High sensitivity for plaque identification

  • Calcifications can be visualized

  • Less ideal for patients requiring follow-up imaging as it uses radiation

+++++++++
MRA
  • Allows for visualization of luminal narrowing without radiation

  • Various modalities such as time of flight (TOF) or contrast enhanced (CE) imaging can be used. TOF is less accurate than CE in assessing luminal stenosis

  • Lower spatial resolution compared with DSA and CTA

  • Arterial wall is not visualized unless it is accompanied by a HR-MRI protocol

  • Contraindications to MRI, such as claustrophobia, not-MRI compatible pacemaker, among others

+++++++
HR-MRI
  • Can visualize the arterial wall and plaque characteristics

  • Identifies non-stenotic plaques with positive remodeling

  • Does not use radiation

  • Higher field of strength modalities such as 7T are not widely available

  • Contraindications to MRI, such as claustrophobia, among others

  • Very sensitive to movement artifact

  • Long acquisition depending on the protocol

+++++++ +++ +
Transcranial
US
  • Non-invasive

  • Provides direct hemodynamic information about the degree of stenosis and possible collateral flow

  • Cannot visualize the plaque directly

  • Information is based on indirect measurements of blood velocity

  • Operator dependent

+++++
IVUS
  • Very high spatial resolution

  • Invasive

  • Neuro probes are not available

+++++++ ++++ +
OCT
  • Highest spatial resolution with good correlation with cellular components

  • Invasive

  • Limited access to neuro probes

++++++++ ++++ +
  • The accuracy of diagnostic ability is marked by the number of plus signs (+), from + (less accurate) to ++++ (most accurate).

  • CTA, CT angiography; DSA, digital subtraction angiography; HR-MRI, high resolution MRI; IVUS, intravenous ultrasound; MRA, MR angiography; OCT, optical coherence tomography.