Non-invasive imaging of atherosclerosis
Francis R Joshi1, Alistair C Lindsay, Daniel R Obaid
1Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Road, Cambridge, UK. frj23@cam.ac.uk
Insights
Atherosclerosis, an inflammatory arterial disease, causes heart attacks and strokes. Advanced imaging techniques beyond lumenography are crucial for detecting plaque rupture risks and guiding therapy.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Inflammatory Diseases
Background:
- Atherosclerosis is a major cause of myocardial infarctions, strokes, and acute coronary syndromes, remaining a global health issue despite risk factor identification and drug therapies.
- Plaque rupture risk is poorly correlated with stenosis severity, highlighting limitations of lumenography which only visualizes the vessel lumen.
- Lumenography does not image the arterial wall where atherosclerosis develops, thus providing no insight into plaque rupture mechanisms.
Purpose of the Study:
- To review various non-invasive imaging modalities used to assess underlying atherosclerotic plaque pathology.
- To highlight the strengths and weaknesses of each imaging technique for evaluating inflammation, calcification, neovascularization, and intraplaque hemorrhage.
- To discuss the potential of non-invasive imaging in tracking anti-atherosclerosis therapy and explore future developments.
Main Methods:
- Review of current literature on non-invasive imaging techniques for atherosclerosis.
- Comparison of modalities including ultrasound, computed tomography, magnetic resonance imaging, and nuclear imaging.
- Analysis of each modality's ability to detect plaque characteristics and monitor therapeutic effects.
Main Results:
- Lumenography is limited to assessing stenosis severity and does not reveal plaque composition or rupture risk.
- Ultrasound, CT, MRI, and nuclear imaging can visualize arterial wall pathology, including inflammation, calcification, neovascularization, and intraplaque hemorrhage.
- Non-invasive imaging is increasingly used to monitor the efficacy of anti-atherosclerosis treatments.
Conclusions:
- Advanced non-invasive imaging modalities are essential for a comprehensive understanding of atherosclerosis beyond lumenography.
- These techniques provide critical information on plaque vulnerability and can guide therapeutic strategies.
- Future developments in imaging promise enhanced capabilities for managing atherosclerotic diseases.
Abstract:
Atherosclerosis is an inflammatory disease that causes most myocardial infarctions, strokes, and acute coronary syndromes. Despite the identification of multiple risk factors and widespread use of drug therapies, it still remains a global health concern with associated costs. It is well known that the risks of atherosclerotic plaque rupture are not well correlated with stenosis severity. Lumenography has a central place for defining the site and severity of vascular stenosis as a prelude to intervention for relief of symptoms due to blood flow limitation. Atherosclerosis develops within the arterial wall; this is not imaged by lumenography and hence it provides no information regarding underlying processes that may lead to plaque rupture. For this, we must rely on other imaging modalities such as ultrasound, computed tomography, magnetic resonance imaging, and nuclear imaging methods. These are capable of reporting on the underlying pathology, in particular the presence of inflammation, calcification, neovascularization, and intraplaque haemorrhage. Additionally, non-invasive imaging can now be used to track the effect of anti-atherosclerosis therapy. Each modality alone has positives and negatives and this review will highlight these, as well as speculating on future developments in this area.
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