Clinical feasibility of molecular imaging of plaque inflammation in atherosclerosis
Nobuhiro Tahara1, Tsutomu Imaizumi, Renu Virmani
1University of California, Irvine, California, USA.
Insights
Molecular imaging can detect inflammation in vulnerable plaques causing acute coronary events, even if not critically obstructive. This approach aids in identifying the causes of heart attacks.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Molecular Biology
Background:
- Coronary artery disease (CAD) management has advanced, yet acute coronary events persist.
- Culprit lesions in acute events are not always critically obstructive or causing inducible ischemia.
- Plaque vulnerability features include large necrotic cores, positive remodeling, and thin fibrous caps.
Purpose of the Study:
- To review the role of molecular imaging in identifying vulnerable plaques.
- To assess the feasibility of detecting plaque inflammation in acute vascular events.
Main Methods:
- Review of CT angiography, intravascular ultrasound, and optical coherence tomography for plaque morphology.
- Evaluation of molecular imaging techniques for detecting monocyte-macrophage infiltration.
- Focus on (18)F-FDG and (99m)Tc-annexin-A5 in clinical settings of acute vascular events.
Main Results:
- Vulnerable plaques exhibit specific morphological characteristics detectable by imaging.
- Fibrous cap inflammation, marked by monocyte-macrophage infiltration, is a key vulnerability component.
- (18)F-FDG and (99m)Tc-annexin-A5 show clinical feasibility for imaging inflammation in acute events.
Conclusions:
- Molecular imaging is crucial for identifying fibrous cap inflammation in vulnerable plaques.
- Current strategies like (18)F-FDG and (99m)Tc-annexin-A5 demonstrate potential for clinical application in acute vascular events.
- Imaging inflammation offers a new dimension in understanding and managing acute coronary events.
Abstract:
Despite substantial advances in the diagnosis and management of coronary artery disease, acute coronary events continue to occur in many patients. It has been increasingly realized that the lesions responsible for acute events may not necessarily be critically obstructive and hence not be associated with inducible ischemia. Various morphologic features of plaque vulnerability have been described by CT angiography, intravascular ultrasound, and optical coherence tomography. The culprit plaques often demonstrate large plaque and necrotic core volumes, positive vascular remodeling, and attenuation of fibrous plaque caps. The remaining obligatory component of plaque vulnerability is fibrous cap inflammation; molecular imaging is best suited for identification of monocyte-macrophage infiltration. Whereas multiple candidate targets have been evaluated in preclinical molecular imaging studies, only (18)F-FDG and (99m)Tc-annexin-A5 have been recently used in the settings of acute vascular events. These 2 imaging strategies have demonstrated the clinical feasibility of imaging for detection of inflammation.
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