Imaging of subclinical atherosclerosis in children and young adults

Atherosclerosis begins in childhood and has a long preclinical phase before ischaemic symptoms appear. This provides an opportunity for subclinical detection of the disease and identification of high-risk subjects. Recent advances in imaging technology have identified many early functional and structural vascular changes, some of which may reflect subclinical atherosclerosis, and therefore provide areas of potential interest for diagnostic tests of preclinical atherosclerosis. These early events include changes in arterial vasodilatory function, alterations in arterial elasticity, thickening of arterial walls and calcification of atherosclerotic lesions. Clinical testing for presymptomatic atherosclerosis should involve methods that are safe, noninvasive, reliable and reproducible, and which correlate with the extent of the atherosclerotic process. Although no such tests are currently widely used in clinical practice, potential methods for detecting the processes outlined above include ultrasound, positron emission tomography, magnetic resonance imaging and ultrafast computed tomography. With further developments, noninvasive imaging techniques for the study of arterial function and structure may soon provide clinically useful ways of detecting early atherosclerosis in high-risk asymptomatic subjects at a stage where preventive strategies are most likely to have important health benefits.