Current imaging modalities to visualize vulnerability within the atherosclerotic carotid plaque

Abstract

There is a promising role for functional molecular imaging modalities like PET, SPECT, or NIRS related to improvement of selection criteria for carotid intervention, especially when combined with CT or MRI to add further anatomical details to molecular information. Further information will be needed to define whether and where this functional molecular imaging will fit into a clinical strategy.

Microstructure-based biomechanics of coronary arteries in health and disease

“…A very exciting application of the approach is patient-specific computational analysis based on medical imaging to provide diagnosis, virtual planning of therapy and prediction of prognosis. Realistic geometries of diseased vessels acquired by IVUS, OCT, computed tomography (CT), and magnetic resonance imaging (MRI), etc., can provide patient-specific models (Wallis de Vries et al, 2008; Holzapfel et al, 2014). IVUS allows for 3D reconstruction of in vivo arteries and can distinguish between tissue by using a radiofrequency spectral approach (Imoto et al, 2005; Moore et al, 1998; Nasu et al, 2006).…”

Neuroimaging of the Vulnerable Plaque

“…Then, together with results from systemic laboratory values, it will be possible for the clinician to decide whether to treat or not and what therapeutic methods to se, medical versus surgical versus endovascular. Thus, at least where carotid stenosis is considered, we have reached a moment when multimodality imaging allows us to combine high-resolution techniques such as fine-slice CT, High speed MRI with molecular functional techniques that depict plaque physiology [29]. …”

Imaging to End Points

“…The use of <3mm spotty calcifications and 1mm diameter foci of low attenuation (<40HU) as signs of high risk plaque would require higher resolution acquisitions (more radiation) and perfectly timed contrast administration. The latter component is even more critical as some high risk plaques may enhance or washout rapidly depending on the inflammatory status in addition to the wide range of variability in densities noted in atherosclerotic plaque 12–14 . Many of the challenges associated with CT are overcome by high field MRI which has improved signal to noise and as well as spatial and temporal resolution 15–17 .…”

“…Many of the challenges associated with CT are overcome by high field MRI which has improved signal to noise and as well as spatial and temporal resolution 15–17 . The technical versatility of MRI also allows for plaque characterization 12, 14 . The relative technical simplicity, mobility and lower cost of ultrasound places this modality at an advantage for claustrophobic patients and locations that might not have the MRI capabilities 12, 14 .…”

“…The technical versatility of MRI also allows for plaque characterization 12, 14 . The relative technical simplicity, mobility and lower cost of ultrasound places this modality at an advantage for claustrophobic patients and locations that might not have the MRI capabilities 12, 14 . Given these factors and available alternatives, translation of the findings of this study into clinical practice may be challenging.…”