The vulnerable coronary plaque: update on imaging technologies

Abstract

Several studies have been carried out on vulnerable plaque as the main culprit for ischaemic cardiac events. Historically, the most important diagnostic technique for studying coronary atherosclerotic disease was to determine the residual luminal diameter by angiographic measurement of the stenosis. However, it has become clear that vulnerable plaque rupture as well as thrombosis, rather than stenosis, triggers most acute ischaemic events and that the quantification of risk based merely on severity of the arterial stenosis is not sufficient. In the last decades, substantial progresses have been made on optimisation of techniques detecting the arterial wall morphology, plaque composition and inflammation. To date, the use of a single technique is not recommended to precisely identify the progression of the atherosclerotic process in human beings. In contrast, the integration of data that can be derived from multiple methods might improve our knowledge about plaque destabilisation. The aim of this narrative review is to update evidence on the accuracy of the currently available non-invasive and invasive imaging techniques in identifying components and morphologic characteristics associated with coronary plaque vulnerability.

18F-NaF Uptake by Atherosclerotic Plaque on PET/CT Imaging: Inverse Correlation Between Calcification Density and Mineral Metabolic Activity

“…Modern histopathologic research has confirmed this hypothesis, demonstrating the presence of cells deriving from osteoblastic and osteoclastic lineage in areas of vascular calcification (2,3). These characteristics allow for the use of CT to assess calcification and generate a clinical calcification score, which is widely regarded as a sound index of the burden and extent of atherosclerotic plaque (4,5). However, a calcification score represents only a static picture, not the pathophysiologic behavior of plaque, and may not fully correlate with a patient's clinical status and cardiovascular risk (6)(7)(8).…”

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“…This factor makes it potentially useful for the identification of vulnerable plaque115 and individuals with high CVD risk 22, 64, 116…”

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