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Atherosclerosis is the basis of the majority of carotid artery disease which, via occlusive/stenotic disease and subsequent thromboembolic events, results in end organ (brain) damage. An element of the atheromatous plaque now becoming appreciated as potentially important in progression and rupture is intraplaque hemorrhage (IPH). Applying T1-weighted magnetic resonance imaging (MRI) to patients suspected of suffering deep vein thrombosis or pulmonary embolism, the identification of high signal within the deep veins of the legs or the arteries of the lungs was shown to accurately identify intravascular thrombus. At the same time as intravascular methemoglobin was under investigation there was increasing interest in using MRI to directly image atherosclerotic disease within the vessel wall. Exploiting the already proven ability of MRI to generate high signal from methemoglobin, the possibility exists to specifically target hemorrhage within plaque using this technique.
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