Molecular imaging in atherosclerosis
Andor W J M Glaudemans1, Riemer H J A Slart, Alessandro Bozzao
1Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Insights
Atherosclerosis, a key cause of cardiovascular disease, involves complex processes including inflammation. Advanced imaging techniques, particularly nuclear imaging, show promise for predicting clinical events and developing targeted therapies.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Pathobiology
Background:
- Atherosclerosis is a primary cause of cardiovascular disease, leading to significant morbidity and mortality.
- Disease development involves multiple risk factors and pathobiological processes, resulting in distinct plaque remodeling stages.
- Emerging research highlights inflammation's crucial role alongside lipids in all atherosclerosis stages.
Purpose of the Study:
- To review the different stages of atherosclerosis and their clinical relevance.
- To describe the molecular events underlying atherosclerosis development.
- To discuss various imaging modalities for assessing atherosclerotic plaques across disease stages.
Main Methods:
- Review of non-nuclear invasive imaging techniques (e.g., intravascular ultrasound, OCT).
- Review of non-nuclear non-invasive imaging techniques (e.g., CT angiography, MRI).
- Focus on nuclear imaging techniques for plaque components, inflammation, and thrombosis.
Main Results:
- Non-nuclear imaging provides anatomical and physiological insights into atherosclerotic plaques.
- Nuclear imaging offers functional information on plaque activity, potentially improving event prediction.
- Current nuclear imaging lacks a definitive tracer for predicting stroke or infarction.
Conclusions:
- Atherosclerosis is a complex inflammatory and lipid-driven disease.
- Advanced imaging, especially nuclear techniques, is crucial for understanding plaque biology and progression.
- Future development of targeted nuclear tracers could revolutionize diagnosis and therapy for cardiovascular disease.
Abstract:
Atherosclerosis is the major cause of cardiovascular disease, which still has the leading position in morbidity and mortality in the Western world. Many risk factors and pathobiological processes are acting together in the development of atherosclerosis. This leads to different remodelling stages (positive and negative) which are both associated with plaque physiology and clinical presentation. The different remodelling stages of atherosclerosis are explained with their clinical relevance. Recent advances in basic science have established that atherosclerosis is not only a lipid storage disease, but that also inflammation has a fundamental role in all stages of the disease. The molecular events leading to atherosclerosis will be extensively reviewed and described. Further on in this review different modalities and their role in the different stages of atherosclerosis will be discussed. Non-nuclear invasive imaging techniques (intravascular ultrasound, intravascular MRI, intracoronary angioscopy and intravascular optical coherence tomography) and non-nuclear non-invasive imaging techniques (ultrasound with Doppler flow, electron-bean computed tomography, coronary computed tomography angiography, MRI and coronary artery MR angiography) will be reviewed. After that we focus on nuclear imaging techniques for detecting atherosclerotic plaques, divided into three groups: atherosclerotic lesion components, inflammation and thrombosis. This emerging area of nuclear imaging techniques can provide measures of biological activity of atherosclerotic plaques, thereby improving the prediction of clinical events. As we will see in the future perspectives, at present, there is no special tracer that can be called the diagnostic tool to diagnose prospective stroke or infarction in patients. Nevertheless, we expect such a tracer to be developed in the next few years and maybe, theoretically, it could even be used for targeted therapy (in the form of a beta-emitter) to combat cardiovascular disease.
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