PET Imaging of Carotid Atherosclerosis: Methodology, Implications, and Applications in Neurovascular Disease

Carotid atherosclerosis is a significant cause of incident and recurrent ischemic stroke, with risk not solely related to the degree of luminal stenosis. Multimodal imaging approaches, including positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging, can provide anatomic and molecular evaluation of the atherosclerotic plaque in vivo. Plaque pathophysiology—including the key processes of inflammation and microcalcification—may help characterize stroke risk beyond conventional anatomic assessment alone. This review discusses the use of positron emission tomography in the investigation of carotid atherosclerosis, including methodological considerations, its contributions to our understanding of the underlying disease processes, and how imaging can be used in interventional trials. The clinical implications and potential future applications of positron emission tomography in the assessment and treatment of cerebrovascular disease are also examined.