Imaging of atherosclerotic plaque

Abstract

The behavior and composition of coronary atherosclerotic plaques are ultimately responsible for the threat of acute ischemic events in patients with coronary artery disease. Different imaging modalities have been developed over the last several years in order to better characterize the atherosclerotic plaque and attempt to predict those in peril of complication. Since its implementation into cardiovascular medicine, nearly 40 years ago, coronary angiography has been the mainstay of identifying hemodynamically stenotic lesions. Further investigation into imaging modalities have suggested, however, that the degree of stenosis is only one of several factors influencing a plaque's tendency to rupture. Recent advances in imaging modalities, including invasive and non-invasive studies, have allowed us to examine the histological components that comprise these plaques. Specific information such as variations in temperature, plaque stiffness and calcification level is currently being researched as well as biological and chemical markers. The ultimate goal is to visualize the plaque and its characteristics, stratify its risk for acute events, be able to apply this modality to the general population of cardiac patients, while exposing the patient to minimal risk and having adequate positive and negative predictive values. This manuscript will review the more recent data concerning these interventions and their individual characteristics.

Association of high-density lipoprotein levels and carotid atherosclerotic plaque characteristics by magnetic resonance imaging

“…[3][4][5][6] The development of an imaging technique that can characterize atherosclerotic plaque composition change in response to HDL-raising therapy is important to further understand the biology of HDL. MRI is ideal for longitudinal plaque imaging studies because it is non-invasive and superior to other modalities in discriminating plaque tissue composition.…”

“…[5] Visualization of these effects by HDL-raising therapy on plaque composition is not possible with angiography or other imaging techniques that are limited to vessel lumen characterization. [6] Highresolution magnetic resonance imaging (MRI) is a non-invasive technique that allows assessment of atherosclerotic plaque composition and volume. [7][8][9] MRI has been used to assess in-vivo regression of carotid plaque burden and lipid content in response to lipid altering therapy.…”

Effects of Stent Design and Atherosclerotic Plaque Composition on Arterial Wall Biomechanics

“…Further advancement in imaging techniques, optical coherence tomography, intravascular ultrasound, and magnetic resonance imaging, have allowed better characterization of the histological components of atherosclerotic plaques and have considerable potential to better assist in the development of patient-specific modeling. 8 An alternate strategy is to construct more ''generic'' models of the artery wall that are more suitable for delineating differences between stent designs. Generic models of the artery wall (with or without diseased segments), while appearing less relevant to the clinical application, have some advantages in the investigation of the effects of stent design.…”

ARFI Imaging for Noninvasive Material Characterization of Atherosclerosis Part II: Toward In Vivo Characterization

“…Imaging techniques in practice and under development that aim to materially characterize atherosclerotic plaques include X-ray computed tomography (CT) (Raggi et al 2005; Schuijf et al 2006), magnetic resonance imaging (MRI) (Yuan et al 2006), intravascular ultrasound (IVUS) integrated backscatter (IB) and virtual histology (VH) methods (Amano et al 2007; Boese et al 2004; Bose et al 2007; Granada et al 2006, Nair et al 2002 ), and IVUS elastography (De Korte et al 2002; Baldewsing et al 2006; Saijo et al 2006). Although IVUS offers many advantages over angiography, its widespread use in clinical practice may be partially limited by its invasive nature, which carries a certain level of risk (Pulido et al 2004; Bose et al 2007). …”