1. Unmasking complicated atherosclerotic plaques on carotid magnetic resonance angiography: A report of three cases 
Max Wintermark, MD, Joseph H. Rapp, MD, Jessica Tan, MSt, David Saloner, PhD 
Journal of Vascular Surgery 
Volume 44, Issue 4, Pages (October 2006)
DOI: /j.jvs
Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

2. Fig 1
A 77-year-old man was admitted to our institution after an episode of presyncope, followed by spontaneous complete recovery. The patient did not report any prodromal or postictal symptoms. Upon his admission, the patient had a noncontrast CT of the head that was unremarkable. (A) An ultrasound of the left carotid bifurcation demonstrated a heterogenous plaque (arrows) involving most of the internal carotid artery bulb, containing a superficial echolucent area (arrowheads), immediately subjacent to the lumen. (B) The precontrast source images of the gadolinium-enhanced MR, used as a mask, demonstrated a focal increased T1 signal (arrows on the coronal, arrowheads on the axials) in the medial wall of the proximal left internal carotid artery, at the exact site where the focal echolucent area was observed on ultrasound images. The same focal increased signal was present on the postcontrast images. Since the increased T1 signal remained unchanged on the pre- and postcontrast images, it was completely subtracted and did not show up on the MIPs, which showed only a severe stenosis of the proximal left internal carotid artery, immediately after the bifurcation.
Journal of Vascular Surgery  , DOI: ( /j.jvs )
Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

3. Fig 2
A 63-year-old man presented with a 1-week history of successive episodes of lightheadedness, transient blindness, right face numbness, and brief right arm tingling. The precontrast source images, used as a mask, demonstrated a focal increased T1 signal (arrows) in the posterior wall of the proximal left internal carotid artery, again interpreted as hemorrhage within a carotid atherosclerotic plaque. The increased T1 signal was present unchanged on the postcontrast images but subtracted on the maximal intensity projections (MIPs), showing only a severe stenosis of the proximal left internal carotid artery immediately distal to the bifurcation.
Journal of Vascular Surgery  , DOI: ( /j.jvs )
Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

4. Fig 3
A 77-year-old man was admitted with an acute stroke in the right middle cerebral artery distribution. As in the first two cases, the precontrast source images demonstrated a focal increased T1 signal in the medial wall of the proximal right internal carotid artery. The same focal increased signal was present on the postcontrast images. Because the increased T1 signal remained unchanged on the precontrast and postcontrast images, it was not apparent on either the subtraction images or on the maximal intensity projections (MIPs).
Journal of Vascular Surgery  , DOI: ( /j.jvs )
Copyright © 2006 The Society for Vascular Surgery Terms and Conditions