Carotid Plaque-RADS: A Novel Stroke Risk Classification System

doi:10.1016/j.jcmg.2023.09.005

. 2024 Jan;17(1):62-75.

doi: 10.1016/j.jcmg.2023.09.005. Epub 2023 Oct 11.

Carotid Plaque-RADS: A Novel Stroke Risk Classification System

Luca Saba¹, Riccardo Cau², Alessandro Murgia², Andrew N Nicolaides³, Max Wintermark⁴, Mauricio Castillo⁵, Daniel Staub⁶, Stavros K Kakkos⁷, Qi Yang⁸, Kosmas I Paraskevas⁹, Chun Yuan¹⁰, Myriam Edjlali¹¹, Roberto Sanfilippo¹², Jeroen Hendrikse¹³, Elias Johansson¹⁴, Mahmud Mossa-Basha¹⁰, Niranjan Balu¹⁵, Martin Dichgans¹⁶, David Saloner¹⁷, Daniel Bos¹⁸, H Rolf Jager¹⁹, Ross Naylor²⁰, Gavino Faa²¹, Jasjit S Suri²², Justin Costello²³, Dorothee P Auer²⁴, J Scott Mcnally²⁵, Leo H Bonati²⁶, Valentina Nardi²⁷, Aad van der Lugt²⁸, Maura Griffin²⁹, Bruce A Wasserman³⁰, M Eline Kooi³¹, Jonathan Gillard³², Giuseppe Lanzino³³, Dimitri P Mikhailidis³⁴, Daniel M Mandell³⁵, John C Benson³⁶, Dianne H K van Dam-Nolen²⁸, Anna Kopczak³⁷, Jae W Song³⁸, Ajay Gupta³⁹, J Kevin DeMarco⁴⁰, Seemant Chaturvedi⁴¹, Renu Virmani⁴², Thomas S Hatsukami¹⁵, Martin Brown⁴³, Alan R Moody⁴⁴, Peter Libby⁴⁵, Andreas Schindler⁴⁶, Tobias Saam⁴⁷

Affiliations

¹ Department of Radiology, University of Cagliari, Cagliari, Italy. Electronic address: lucasaba@tiscali.it.
² Department of Radiology, University of Cagliari, Cagliari, Italy.
³ Vascular Screening and Diagnostic Centre, Nicosia, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus; Department of Vascular Surgery, Imperial College, London, United Kingdom.
⁴ Department of Neuroradiology, The University of Texas MD Anderson Center, Houston, Texas, USA.
⁵ Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA.
⁶ Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland.
⁷ Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
⁸ Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁹ Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece.
¹⁰ Department of Radiology, University of Washington, Seattle, Washington, USA.
¹¹ Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, CEA, CNRS, Inserm, Frédéric Joliot Hospital Department, Orsay, France; Department of Radiology, APHP, Paris, France.
¹² Department of Vascular Surgery, University of Cagliari, Cagliari, Italy.
¹³ University Medical Center Utrecht, Utrecht, the Netherlands.
¹⁴ Clinical Science, Umeå University, Neurosciences, Umeå, Sweden.
¹⁵ Department of Surgery, University of Washington, Seattle, WA, USA.
¹⁶ Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
¹⁷ Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA.
¹⁸ Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
¹⁹ Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom.
²⁰ The Leicester Vascular Institute, Glenfield Hospital, Leicester, United Kingdom.
²¹ Department of Pathology, University of Cagliari, Cagliari, Italy.
²² Stroke Monitoring and Diagnostic Division, AtheroPoin, Roseville, California, USA.
²³ Department of Neuroradiology, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
²⁴ Radiological Sciences, Division of Clinical Neuroscience, and NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom.
²⁵ Department of Radiology, University of Utah, Salt Lake City, Utah, USA.
²⁶ Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
²⁷ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
²⁸ Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands.
²⁹ Vascular Screening and Diagnostic Centre, Nicosia, Cyprus.
³⁰ Department of Radiology, University of Maryland School of Medicine and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³¹ Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.
³² Christ's College, Cambridge, United Kingdom.
³³ Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
³⁴ Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London School, University College London, London, United Kingdom.
³⁵ Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
³⁶ Department of Radiology Mayo Clinic, Rochester, Minnesota, USA.
³⁷ Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany.
³⁸ Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³⁹ Department of Radiology Weill Cornell Medical College, New York, New York, USA.
⁴⁰ Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
⁴¹ Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA.
⁴² Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, Maryland, USA.
⁴³ Department of Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom.
⁴⁴ Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
⁴⁵ Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁴⁶ Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany.
⁴⁷ Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Die Radiologie, Rosenheim, Germany.

PMID: 37823860
DOI: 10.1016/j.jcmg.2023.09.005

Carotid Plaque-RADS: A Novel Stroke Risk Classification System

Luca Saba et al. JACC Cardiovasc Imaging. 2024 Jan.

. 2024 Jan;17(1):62-75.

doi: 10.1016/j.jcmg.2023.09.005. Epub 2023 Oct 11.

Authors

Affiliations

¹ Department of Radiology, University of Cagliari, Cagliari, Italy. Electronic address: lucasaba@tiscali.it.
² Department of Radiology, University of Cagliari, Cagliari, Italy.
³ Vascular Screening and Diagnostic Centre, Nicosia, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus; Department of Vascular Surgery, Imperial College, London, United Kingdom.
⁴ Department of Neuroradiology, The University of Texas MD Anderson Center, Houston, Texas, USA.
⁵ Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA.
⁶ Vascular Medicine/Angiology, University Hospital Basel and University of Basel, Basel, Switzerland.
⁷ Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
⁸ Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
⁹ Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece.
¹⁰ Department of Radiology, University of Washington, Seattle, Washington, USA.
¹¹ Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, CEA, CNRS, Inserm, Frédéric Joliot Hospital Department, Orsay, France; Department of Radiology, APHP, Paris, France.
¹² Department of Vascular Surgery, University of Cagliari, Cagliari, Italy.
¹³ University Medical Center Utrecht, Utrecht, the Netherlands.
¹⁴ Clinical Science, Umeå University, Neurosciences, Umeå, Sweden.
¹⁵ Department of Surgery, University of Washington, Seattle, WA, USA.
¹⁶ Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
¹⁷ Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA.
¹⁸ Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
¹⁹ Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom.
²⁰ The Leicester Vascular Institute, Glenfield Hospital, Leicester, United Kingdom.
²¹ Department of Pathology, University of Cagliari, Cagliari, Italy.
²² Stroke Monitoring and Diagnostic Division, AtheroPoin, Roseville, California, USA.
²³ Department of Neuroradiology, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.
²⁴ Radiological Sciences, Division of Clinical Neuroscience, and NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom.
²⁵ Department of Radiology, University of Utah, Salt Lake City, Utah, USA.
²⁶ Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
²⁷ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
²⁸ Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands.
²⁹ Vascular Screening and Diagnostic Centre, Nicosia, Cyprus.
³⁰ Department of Radiology, University of Maryland School of Medicine and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³¹ Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.
³² Christ's College, Cambridge, United Kingdom.
³³ Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
³⁴ Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London School, University College London, London, United Kingdom.
³⁵ Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.
³⁶ Department of Radiology Mayo Clinic, Rochester, Minnesota, USA.
³⁷ Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany.
³⁸ Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³⁹ Department of Radiology Weill Cornell Medical College, New York, New York, USA.
⁴⁰ Walter Reed National Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
⁴¹ Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA.
⁴² Department of Cardiovascular Pathology, CVPath Institute, Gaithersburg, Maryland, USA.
⁴³ Department of Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom.
⁴⁴ Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
⁴⁵ Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
⁴⁶ Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany.
⁴⁷ Department of Radiology, University Hospital, LMU Munich, Munich, Germany; Die Radiologie, Rosenheim, Germany.

PMID: 37823860
DOI: 10.1016/j.jcmg.2023.09.005

Abstract

Background: Carotid artery atherosclerosis is highly prevalent in the general population and is a well-established risk factor for acute ischemic stroke. Although the morphological characteristics of vulnerable plaques are well recognized, there is a lack of consensus in reporting and interpreting carotid plaque features.

Objectives: The aim of this paper is to establish a consistent and comprehensive approach for imaging and reporting carotid plaque by introducing the Plaque-RADS (Reporting and Data System) score.

Methods: A panel of experts recognized the necessity to develop a classification system for carotid plaque and its defining characteristics. Using a multimodality analysis approach, the Plaque-RADS categories were established through consensus, drawing on existing published reports.

Results: The authors present a universal classification that is applicable to both researchers and clinicians. The Plaque-RADS score offers a morphological assessment in addition to the prevailing quantitative parameter of "stenosis." The Plaque-RADS score spans from grade 1 (indicating complete absence of plaque) to grade 4 (representing complicated plaque). Accompanying visual examples are included to facilitate a clear understanding of the Plaque-RADS categories.

Conclusions: Plaque-RADS is a standardized and reliable system of reporting carotid plaque composition and morphology via different imaging modalities, such as ultrasound, computed tomography, and magnetic resonance imaging. This scoring system has the potential to help in the precise identification of patients who may benefit from exclusive medical intervention and those who require alternative treatments, thereby enhancing patient care. A standardized lexicon and structured reporting promise to enhance communication between radiologists, referring clinicians, and scientists.

Keywords: Plaque-RADS; atherosclerosis; carotid plaque; carotid stenosis; complicated plaque; plaque imaging; reporting and data system; stroke.

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Conflict of interest statement

Funding Support and Author Disclosures The views expressed in this paper are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. The identification of specific products or scientific instrumentation does not constitute endorsement or implied endorsement on the part of the author, Department of Defense, or any component agency. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Multimodality Imaging Classification for Carotid Plaque Assessment.
Naqvi TZ. Naqvi TZ. JACC Cardiovasc Imaging. 2024 Jan;17(1):76-78. doi: 10.1016/j.jcmg.2023.11.004. JACC Cardiovasc Imaging. 2024. PMID: 38176850 No abstract available.

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Carotid Plaque-RADS: A Novel Stroke Risk Classification System

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Carotid Plaque-RADS: A Novel Stroke Risk Classification System

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