Cervical Carotid Plaque MRI: Review of Atherosclerosis Imaging Features and their Histologic Underpinnings

John C. Benson, Heidi Cheek, Marie C. Aubry, Giuseppe Lanzino, John Huston, Alejandro Rabinstein, Waleed Brinjikji

Research output: Contribution to journalReview articlepeer-review


Magnetic resonance (MR) imaging is considered the gold standard for non-invasive evaluation of carotid artery plaque morphology and composition. A number of studies have demonstrated the clinical utility of MR plaque imaging in the risk stratification of carotid atherosclerotic disease, determination of stroke etiology, and identification of surgical and endovascular candidates for carotid revascularization procedures. The MR plaque imaging also provides researchers and clinicians with valuable insights into the pathogenesis, natural history and composition of carotid atherosclerotic disease. Nevertheless, the field of MR plaque imaging is complex, and requires a thorough knowledge of the histologic basis for how various plaque features appear on imaging. This article details the pathogenesis and histology of atherosclerosis, reviews the expected appearance of different plaque components, and describes how MR imaging features may be related to symptomatology or predict future ischemic events.

Original languageEnglish (US)
Pages (from-to)295-306
Number of pages12
JournalClinical Neuroradiology
Issue number2
StatePublished - Jun 2021


  • Atherosclerosis
  • Carotid
  • MRI
  • Pathology
  • Plaque

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology


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