Imaging of atherosclerosis using magnetic resonance: state of the art and future directions

Atherosclerosis is the leading cause of morbidity and mortality in industrialized societies, and its incidence is projected to increase in the future. Because the atherosclerotic process begins in the vessel wall, the focus of cardiovascular imaging is shifting from the arterial lumen to imaging of the vessel wall, with the goal of detecting preclinical atherosclerosis. MRI, because of its high resolution, three-dimensional capabilities, noninvasive nature, and capacity for soft tissue characterization, is emerging as an important modality to assess the atherosclerotic plaque burden in the arterial wall and can monitor atherosclerosis in different arterial beds, including the carotid arteries, aorta, and more recently, the coronary arteries. Furthermore, it has also been successfully utilized to monitor plaque regression following therapeutic interventions. Finally, the emergence of high-resolution MRI and development of sophisticated contrast agents offers tremendous promise for in vivo molecular imaging of the atherosclerotic plaque.