Imaging of atherosclerotic plaque

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.