Artificial intelligence in carotid computed tomography angiography plaque detection: Decade of progress and future perspectives

Abstract

The application of artificial intelligence (AI) in carotid atherosclerotic plaque detection via computed tomography angiography (CTA) has significantly advanced over the past decade. This mini-review consolidates recent innovations in deep learning architectures, domain adaptation techniques, and automated plaque characterization methodologies. Hybrid models, such as residual U-Net-Pyramid Scene Parsing Network, exhibit a remarkable precision of 80.49% in plaque segmentation, outperforming radiologists in diagnostic efficiency by reducing analysis time from minutes to mere seconds. Domain-adaptive frameworks, such as Lesion Assessment through Tracklet Evaluation, demonstrate robust performance across heterogeneous imaging datasets, achieving an area under the curve (AUC) greater than 0.88. Furthermore, novel approaches integrating U-Net and Efficient-Net architectures, enhanced by Bayesian optimization, have achieved impressive correlation coefficients (0.89) for plaque quantification. AI-powered CTA also enables high-precision three-dimensional vascular segmentation, with a Dice coefficient of 0.9119, and offers superior cardiovascular risk stratification compared to traditional Agatston scoring, yielding AUC values of 0.816 vs 0.729 at a 15-year follow-up. These breakthroughs address key challenges in plaque motion analysis, with systolic retractive motion biomarkers successfully identifying 80% of vulnerable plaques. Looking ahead, future directions focus on enhancing the interpretability of AI models through explainable AI and leveraging federated learning to mitigate data heterogeneity. This mini-review underscores the transformative potential of AI in carotid plaque assessment, offering substantial implications for stroke prevention and personalized cerebrovascular management strategies.

Keywords: Carotid artery disease; Artificial intelligence; Deep learning; Computed tomography angiography; Plaque segmentation; Medical image analysis

Core Tip: This is the first mini-review to comprehensively analyze artificial intelligence (AI)-driven advancements in carotid computed tomography angiography plaque detection over ten years. We provide novel insights into hybrid deep learning architectures, domain adaptation techniques, and their clinical translation. The work establishes quantitative benchmarks for diagnostic performance and highlights future directions for explainable AI systems in vascular imaging.