Diagnosis of Atherosclerosis by Imaging
Section snippets
Coronary Angiography
Coronary angiography (Figure 1) was the first modality to become available for in vivo assessment of the coronary arteries. This procedure consists of injection of an iodinated contrast agent through a catheter placed at the ostium of the coronaries. The contrast agent is visible through x-ray fluoroscopic examination of the heart. Coronary angiography depicts “only” a luminogram of the vessel (the vessel space occupied by blood); the actual extent of atherosclerotic plaque volume in the wall
Carotid Plaque
B-mode ultrasound has been established as the imaging modality of choice for visualizing IMT. Abnormal thickening of carotid IMT is considered and has been validated as a marker of generalized atherosclerotic disease.16 In fact, it correlates linearly with the number of atherosclerotic risk factors.17 Arterial wall thickness can also be measured and the structure and composition of atheromatous plaques analyzed with the use of MRI and transthoracic or transesophageal ultrasound, among other
Functional and molecular imaging through noninvasive methods: Future modalities
New techniques based on molecular imaging that are currently under development may make it possible for the clinician to visualize inflammatory and other activities of atheromatous plaque. Such techniques would greatly enhance our ability to understand and assess mechanisms of the atherosclerotic disease process and monitor the efficacy of treatment. Several techniques with sufficient spatial resolution have been developed to facilitate molecular imaging; these include MRI with targeted
Current trials to test the broad clinical usefulness of vascular imaging
The Multi-Ethnic Study of Atherosclerosis (MESA) enrolled (between July 2000 and August 2002) a total of 6,814 men and women aged 45 to 84 years of diverse ethnic origin who were free of clinically apparent cardiovascular disease.69 Baseline data obtained included measurements of the following: coronary calcium by CT; ventricular mass and function by MRI; and flow-mediated brachial artery endothelial vasodilation, carotid IMT, and peripheral vascular disease assessed by means of ankle-brachial
Summary
Atherosclerosis plaque imaging represents a new paradigm in cardiovascular medicine. At a research level, plaque imaging is a powerful tool for evaluating the mechanisms and efficacy of novel drug therapies. At a clinical level, plaque imaging may help clinicians to identify patients at risk who may benefit from secondary prevention strategies. The specific roles of different imaging modalities must be clearly defined. Significant evidence supports the role of the calcium score scan as a
Pearls for clinical guidance
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Common characteristics of atherosclerotic plaques may be determined noninvasively.
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Carotid ultrasound provides a measurement of IMT, which has been related to cardiovascular events and risk factors.
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MRI can reveal total plaque burden across different vascular beds. Resolution most often is limited to large-caliber vessels.
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CT can be used to determine coronary plaque burden and type. In contrast to MRI and ultrasound, this technique requires ionizing radiation.
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Molecular imaging with MRI and/or PET
Author disclosures
The authors who contributed to this article have disclosed the following industry relationships:
Borja Ibañez, MD, has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this article.
Juan J. Badimon, PhD, has served as an advisory board participant (honorarium) for AstraZeneca Pharmaceuticals LP, Lilly-Sankyo, Pfizer Inc, and sanofi aventis.
Mario J. Garcia, MD, is a consultant for Philips Medical Systems and BG Medicine and has
Acknowledgments
We thank Michael Theisen, Dolores Matthews, and Marsha Hall from Scientific Connexions, Newtown, Pennsylvania, who provided editorial assistance funded by AstraZeneca Pharmaceuticals LP.
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