Single- and Dual-Energy Computed Tomography for Brachiocephalic Atherosclerosis Imaging: Review

Brachiocephalic atherosclerosis remain the primary cause of acute cerebral ischemic events, such as ischemic stroke and transient ischemic attack. As reported by the World Health Organization, the ischemic stroke mortality has declined, however remains high at 117.9 per 100,000 population. Recent studies increasingly demonstrate that ischemic stroke and transient ischemic attack are associated with signs of unstable atherosclerotic plaques. Advances in structural vascular imaging techniques, particularly in radiation-based techniques, now enable not only the assessment of stenosis severity but also the detailed evaluation of plaque composition and instability signs, such as intraplaque hemorrhages, lipid-rich necrotic cores with thin fibrous caps, calcifications, and neovascularization. Precise imaging of the extracranial carotid arteries is essential for accurate risk stratification. This review summarizes recent data on the imaging capabilities of computed tomography, including dual-energy computed tomography, in visualizing brachiocephalic atherosclerosis. The review is based on the scientific articles published over the past decade and retrieved from PubMed and eLibrary databases. The analysis includes the scientific articles, Russian and international clinical guidelines on carotid artery disease management that incorporate evidence-based experimental and clinical findings. Computed tomography has been established as a standard diagnostic tool for assessing brachiocephalic atherosclerosis; it is considered the gold standard for assessing stenosis severity and also provides valuable information on plaque morphology, ulceration, etc. Although dual-energy computed tomography broadens the scope to detect signs of unstable plaques, further research and standardization are required.