VASCOLL · QSM in plaque vulnerability diagnosis – a software tool for early clinical assessment

Stroke is the leading cause of disability and the third leading cause of death in the Western World. Over 50% of strokes occur inasymptomatic patients and therefore better indicators of the disease are required. These acute asymptomatic cerebrovascularevents are due to vulnerable plaque rupture leading to thromboembolic events, stroke, and/or sudden death. From our work to-dateas part of ERC Starting grant FibreRemodel, we have found that that most significant contributor to rupture strength of a plaque isthe underlying collagen fibres within this tissue, particularly within the fibrous plaque cap. The underlying structure of the carotidplaque may therefore be used to determine the risk of vulnerable plaque rupture. However, a non-invasive diagnostic technique,which uses knowledge of in vivo arterial collagen content, has yet to be developed. VASCOLL will generate the first software toolthat can inform on plaque vulnerability in a non-invasive way, enabling early diagnosis of the predisposition of a carotid plaque torupture and facilitating the selection of the optimum treatment minimising the need for surgery and healthcare-associated costs.This approach will offer a number of significant benefits over current approaches to vulnerable plaque identification. Firstly, thistechnique will be the first ex vivo and in vivo application of the QSM technique to human arteries and carotid plaques to exploit thesensitivity of magnetic susceptibility to collagen content in arteries. Secondly, this technique is relatively easy and efficient totranslate in vivo. Given that this method determines the underlying plaque and vessel structure, not merely level of stenosis,VASCOLL will transform how vulnerable carotid plaques are identified and treated.