Ancillary plaque features improved Carotid Plaque-RADS for symptomatic plaques

Design

Retrospective diagnostic modelling study

Population

Patients with carotid atherosclerosis on CTA and vessel wall MRI, 2021 to 2024

Primary outcome

Identification of symptomatic carotid plaques

Effect

Integrated model AUC 0.876 (0.828 to 0.924); 0.919 in moderate stenosis

A retrospective study of patients with carotid atherosclerosis who had both CT angiography and high-resolution vessel wall MRI, 2021 to 2024, tested whether ancillary features add to Plaque-RADS.

Stenosis degree, Plaque-RADS category, plaque burden, remodelling index, enhancement ratio and perivascular fat density were each independently associated with symptomatic plaques. A combined model reached an AUC of 0.876 (0.828 to 0.924), and 0.919 in moderate stenosis.

The moderate stenosis group is where decisions are hardest, so a plaque-based signal there matters. This is a single-centre retrospective model without external validation.

• Report Plaque-RADS category alongside stenosis on carotid imaging.
• In moderate stenosis, describe enhancement, remodelling and plaque burden where vessel wall MRI is available.
• Note perivascular fat density on CTA where measurable.
• Do not use the model score for treatment decisions until externally validated.

Why it matters

Stenosis alone underestimates stroke risk from vulnerable plaque, especially at moderate degrees.

Don't overread it

A retrospective single-centre model — AUC is likely to fall on external validation.

The statistics, in plain English

An AUC of 0.876 means the model ranks a symptomatic plaque above an asymptomatic one about 88% of the time. Models tested on the data they were built from tend to look better than they will elsewhere.

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