Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art

Abstract

The ability to image obstructive arterial disease brought about a revolution in clinical cardiovascular care; the development of newer technologies that image arterial wall thicknesses, areas, volumes, and composition allows valid imaging of atherosclerosis for the first time. Development of noninvasive imaging of atherosclerosis has further led to a quantum shift in research in the field by enabling the study of asymptomatic populations and thus allowing investigators to focus on preclinical disease without the many biases associated with the study of symptomatic patients. These noninvasive investigations have broad implications for clinical care as well. Coronary angiography, computed tomographic (CT) imaging of coronary calcium, intravascular ultrasound, multidetector CT angiography, B mode ultrasound of the carotid arteries, and MRI of the carotid arteries all have unique strengths and weaknesses for imaging atherosclerosis. Certain of these techniques are extremely useful as outcome variables for clinical trials, and others are uniquely useful as predictors of the risk of cardiovascular disease. All are informative in one way or another with regard to the role of plaque remodeling and composition in disease causation. CT and MRI technology are advancing very rapidly, and research and clinical uses of these imaging modalities promise to further advance our understanding of atherosclerosis and its prevention.-Crouse, J. R., III. Imaging atherosclerosis: state of the art.

Carotid intima-media thickness for the practicing lipidologist

“…26 The role of CIMT as an independent predictor for vascular events in patients with known disease, reflecting its usefulness as a surrogate marker in these populations, was questioned in a handful of studies. [41][42][43] Although in aggregate the data suggest that there is a graded relationship between increasing CIMT and vascular risk, the relationship of CIMT with clinical end points of MI or stroke might be reduced when this relationship is corrected for standard risk factors of age, dyslipidemia, smoking, previous MI, hypertension, and diabetes. However, the SMART study recently demonstrated a relationship between CIMT and new vascular events even in patients with known, clinically significant and symptomatic coronary, cerebrovascular, or peripheral arterial disease.…”

“…40 Crouse in the Journal of Lipid Research compiled an extensive list of both traditional and nontraditional risk factors associated with CIMT. 41 The Bogalusa Heart Study is a long-term epidemiologic study of a cohort of young adults (mean age 32 years; 71% white, 39% male) from the semi-rural, biracial community of Bogalusa, Louisiana. 26 In this study, age, race (black more than white), high-density lipoprotein (HDL) cholesterol, LDL cholesterol, and insulin were independent predictors of increased IMT in the common carotid and bulb segments.…”

Assessment of atherosclerosis in large vessel walls: A comprehensive review of FDG-PET/CT image acquisition protocols and methods for uptake quantification

“…71,72 Change in the vascular transverse area is associated with vascular wall remodeling in the setting of atherosclerosis and is commonly seen as vascular enlargement. 66,73,74 This change is associated with unstable plaques and higher incidence of cardiovascular events. 75 Vessel transverse area is sensitive to anti-atherosclerosis treatments 65,66 and is associated with increased FDG uptake activity.…”

Atherosclerosis Imaging

“…Most efforts have focused on the visualization of plaque or its components and a number of imaging modalities to detect atherosclerosis are currently available. 27 Two modalities, coronary artery calcium (CAC) score, often measured by computed tomography (CT), and carotid intima-medial thickness (CIMT), measured by B-mode ultrasound, have the most potential and the largest body of supporting data. They will form the focus of this review.…”