PICACHU study – assessment of perivascular inflammation in carotid arteries on computed tomographic angiography with histopathological correlation in a stroke population
Patients who present with suspected ischaemic stroke routinely undergo carotid computed tomographic angiography (CTA), an imaging study that assesses the arteries in the neck. A major cause of ischaemic stroke is atherosclerosis, which is a disease associated with inflammation.
Clinically, carotid CTA is used to identify atherosclerotic plaque and measure the severity of narrowing in the internal carotid artery (ICA) to inform treatment decisions. Patients with high-grade ICA stenosis are treated surgically with an operation called carotid endarterectomy (CEA) to remove the diseased section of the ICA.
- Recent studies have shown a biomarker of inflammation on coronary CTA by measuring the density of perivascular fat. The PICACHU study aims to apply this imaging biomarker to carotid CTA, with the potential to identify patients who may benefit from anti-inflammatory treatment.
- Other features of atherosclerotic disease may also be assessed on carotid CTA, however, there is no widely used system of assessing plaque. This study aims to develop a reporting proforma for plaque analysis.
- Carotid CTA will be analysed with artificial intelligence/radiomics to identify additional clinically relevant imaging features that have not yet been studied.
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