Figure 3

Example of partial volume and flow disturbance in a large penetrating ulcer. The cross-sectional CMR images alone could not verify the presence of the ulcer in the left carotid artery. The signal pattern of the ulcer resembles the signal pattern of intraplaque hemorrhage (arrows). However, the longitudinal black-blood CMR (BB CMR) angiography shows clear separation between the very narrow lumen and the penetrating ulcer due to the improvement of spatial resolution in the longitudinal direction. The flow artifact with this ulcer can be easily identified. Corresponding histology confirms the presence of the ulcer. CE-T1W is not shown. PDW = proton density weighted. Int = internal carotid artery. Ext = external carotid artery. Common = common carotid artery. JV = jugular vein.