Molecular Imaging in Cardiovascular Diseases

Abstract

Cardiovascular diseases remain the leading cause of morbidity and mortality in industrialized and developing countries. In clinical practice, the in-vivo identification of atherosclerotic lesions, which can lead to complications such as heart attack or stroke, remains difficult. Imaging techniques provide the reference standard for the detection of clinically significant atherosclerotic changes in the coronary and carotid arteries. The assessment of the luminal narrowing is feasible, while the differentiation of stable and potentially unstable or vulnerable atherosclerotic plaques is currently not possible using non-invasive imaging. With high spatial resolution and high soft tissue contrast, magnetic resonance imaging (MRI) is a suitable method for the evaluation of the thin arterial wall. In clinical practice, native MRI of the vessel wall already allows the differentiation and characterization of components of atherosclerotic plaques in the carotid arteries and the aorta. Additional diagnostic information can be gained by the use of non-specific MRI contrast agents. With the development of targeted molecular probes, that highlight specific molecules or cells, pathological processes can be visualized at a molecular level with high spatial resolution. In this review article, the development of pathophysiological changes leading to the development of the arterial wall are introduced and discussed. Additionally, principles of contrast enhanced imaging with non-specific contrast agents and molecular probes will be discussed and latest developments in the field of molecular imaging of the vascular wall will be introduced. Key Points: ??Molecular magnetic resonance imaging has great potential to improve the in vivo characterization of atherosclerotic plaques. ??Based on the molecular information is feasible to enable a better differentiation of stable and unstable (vulnerable) atherosclerotic plaques. Citation Format: ??Botnar RM, Ebersberger H, Noerenberg D et?al. Molecular imaging in cardiovascular diseases. Fortschr R?ntgenstr 2015; 187: 92???101

Simultaneous bright‐ and black‐blood whole‐heart MRI for noncontrast enhanced coronary lumen and thrombus visualization

“…The BOOST sequence proposed in this work showed promising results for both bright‐blood and black‐blood coronary artery imaging and now warrants corroborating our preliminary findings in patients with coronary thrombus, complex plaque, or intraplaque hemorrhage. In addition, the suitability of the proposed BOOST framework for coronary plaque characterization in concert with contrast agents needs to be investigated in patients with stable and unstable angina . Furthermore, the T 2 Prep‐IR bright‐blood volumes obtained with the proposed BOOST sequence showed improved coronary %VS and CNR between blood and myocardium in comparison to a conventional CMRA acquisition.…”

Molecular Cardiovascular Magnetic Resonance: Current Status and Future Prospects

“…Visualization of specific receptors, molecules or cells is obtained by selective binding of the molecular MR probe. Another possibility to increase contrast enhancement is the accumulation of the probe on grounds of pathological tissue characteristics or specific cell types, e.g., the phagocytosis of iron oxide particles by macrophages [19].…”

Combined PET/MRI: Multi-modality Multi-parametric Imaging Is Here

“…However, similar and complementary parameters can be derived from PET and single photon emission tomography (SPECT) measurements with the advantage of a wider range of specific radiopharmaceuticals that can be used to probe various aspects of cardiac pathology such as post-ischemic inflammation and nerve function. While new concepts for molecular imaging are currently being pursued with MRI, clinical translation of these methods is, however, often lacking [5,6]. PET and MRI provide many similar measurements in cardiac imaging, e.g.…”