New methods to image unstable atherosclerotic plaques

Atherosclerotic plaque rupture is the primary mechanism responsible for myocardial infarction and stroke, the top two killers worldwide. Despite being potentially fatal, the ubiquitous prevalence of atherosclerosis amongst the middle aged and elderly renders individual events relatively rare. This m...

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Bibliographic Details
Published in:Atherosclerosis 2018-05, Vol.272, p.118-128
Main Authors: Andrews, Jack P.M., Fayad, Zahi A., Dweck, Marc R.
Format: Article
Language:English
Subjects:
Annexin A5 - chemistry
Apoptosis
Atherosclerosis - diagnostic imaging
Computed tomography
Coronary Artery Disease - diagnostic imaging
Diagnostic Imaging - methods
Diagnostic Imaging - trends
Fluorodeoxyglucose F18
Gallium Radioisotopes
Humans
Hypoxia
Inflammation
Ligands
Magnetic Resonance Imaging
Myocardial Infarction - diagnostic imaging
Neovascularization, Physiologic
Plaque, Atherosclerotic - diagnostic imaging
Positron emission tomography
Radiopharmaceuticals
Reproducibility of Results
Risk Assessment
Stroke - diagnostic imaging
Tomography, X-Ray Computed
Unstable plaque
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Summary:Atherosclerotic plaque rupture is the primary mechanism responsible for myocardial infarction and stroke, the top two killers worldwide. Despite being potentially fatal, the ubiquitous prevalence of atherosclerosis amongst the middle aged and elderly renders individual events relatively rare. This makes the accurate prediction of MI and stroke challenging. Advances in imaging techniques now allow detailed assessments of plaque morphology and disease activity. Both CT and MR can identify certain unstable plaque characteristics thought to be associated with an increased risk of rupture and events. PET imaging allows the activity of distinct pathological processes associated with atherosclerosis to be measured, differentiating patients with inactive and active disease states. Hybrid integration of PET with CT or MR now allows for an accurate assessment of not only plaque burden and morphology but plaque biology too. In this review, we discuss how these advanced imaging techniques hold promise in redefining our understanding of stable and unstable coronary artery disease beyond symptomatic status, and how they may refine patient risk-prediction and the rationing of expensive novel therapies. •Individualised cardiovascular risk predication is challenging due to the almost ubiquitous presence of atherosclerosis amongst the middle aged and elderly.•Non-invasive imaging techniques can provide accurate assessments of plaque burden, plaque morphology and disease activity.•Certain unstable plaque characteristics are association with an increased propensity to plaque rupture and events. Many of these can be detected using modern non-invasive imaging.•Atherosclerotic PET imaging can quantify disease activity in the coronary, aorta and carotid arteries. In particular, the activity of inflammation and calcification can be measured.•Hybrid imaging with PET and either CT or MR allows for a multifaceted assessment including the differentiation of active and unstable disease states from stable quiescent ones.
ISSN:0021-9150
1879-1484
1879-1484
DOI:10.1016/j.atherosclerosis.2018.03.021