Coronary plaque composition of nonculprit lesions, assessed by in vivo intracoronary ultrasound radio frequency data analysis, is related to clinical presentation

Therapeutic modulation of the natural history of coronary atherosclerosis: lessons learned from serial imaging studies

“…However, coronary artery imaging remains difficult due to background FDG uptake by the myocardium, along with the low spatial resolution of PET and small size of coronary arteries, and artefactual noise from cardiac motion, making FDG-PET inadequate for clinical assessment of CAD. Furthermore, there is also the matter of total body radiation exposure which is in the order of 7 mSv with contemporary myocardial 18 F-FDG PET imaging Experimental studies have demonstrated greater FDG uptake in plaques containing a large proportion of macrophages, suggesting that this approach may be used to evaluate the impact of therapies on the inflammatory composition of atherosclerotic plaques (40). More recently PET-based imaging of 18 F-sodium fluoride uptake has been used to detect high risk features of unstable plaque in patients with carotid and coronary atherosclerosis (41).…”

“…Furthermore, there is also the matter of total body radiation exposure which is in the order of 7 mSv with contemporary myocardial 18 F-FDG PET imaging Experimental studies have demonstrated greater FDG uptake in plaques containing a large proportion of macrophages, suggesting that this approach may be used to evaluate the impact of therapies on the inflammatory composition of atherosclerotic plaques (40). More recently PET-based imaging of 18 F-sodium fluoride uptake has been used to detect high risk features of unstable plaque in patients with carotid and coronary atherosclerosis (41). Although far from primetime, the integration of less invasive imaging techniques, such as MRI and PET with molecular targeted agents holds potential for evaluating new therapies on specific targets in atherosclerotic plaque that are associated with rupture (42).…”

“…Several radionuclidelabeled tracers have been developed to image inflammation, angiogenesis, apoptosis and lipid metabolism (39). PET imaging with 18 F-fluorodeoxyglucose (FDG) has been considered to be especially promising imaging modality for the identification of vulnerable lesions. However, coronary artery imaging remains difficult due to background FDG uptake by the myocardium, along with the low spatial resolution of PET and small size of coronary arteries, and artefactual noise from cardiac motion, making FDG-PET inadequate for clinical assessment of CAD.…”

“…A reconstructed color-coded tissue map of plaque composition is superimposed onto cross-sectional images of the coronary artery obtained by grayscale IVUS, that distinguishes between fibrous, fibrofatty, necrotic core and dense calcific material (17). VH-IVUS has been applied in clinical settings to demonstrate the association between cardiovascular events and plaque containing greater quantities of both necrotic and lipidic material (18). These associations have led to the integration of VH-IVUS in studies evaluating the biological effects of antiatherosclerotic therapies.…”

“…Forty-three patients who underwent 18 FDG-PET for cancer screening and had radio-tracer uptake in the thoracic aorta and/or carotid arteries, were either treated with simvastatin or dietary management (52). Simvastatin reduced LDL-C by 30% (P<0.01) and increased HDL-C by 15% (P<0.01), whereas LDL-C and HDL-C levels were not changed in the diet group.…”