Targeting the vulnerable plaque: the evolving role of nuclear imaging.
The majority of acute ischemic events relating to atherosclerosis are caused by plaque rupture and ensuing thrombosis. The risk of plaque rupture is dictated in part by plaque morphology, which in turn is influenced by pathophysiologic mechanisms at the cellular and molecular level. Anatomic imaging modalities such as intravascular ultrasound, high-resolution magnetic resonance imaging, and multislice computed tomography can identify morphologic features of the vulnerable plaque, such as a large lipid core and thin fibrous cap, but give little or no information regarding molecular and cellular mechanisms, such as endothelial function, macrophage activation, lipid transport and metabolism, and cell death. Recent studies suggest that nuclear imaging may be able to provide images of sufficient quality to identify and quantify some of these molecular and cellular pathophysiologic processes. In the future this could allow for the early identification and noninvasive monitoring of vulnerable plaque.
Davies
John R
JR
Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, ACCI Building, Hills Road, Cambridge CB2 2QQ, UK. jrd36@mole.bio.cam.ac.uk
Rudd
James F
JF
Fryer
Tim D
TD
Weissberg
Peter L
PL
D000818:Animals; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D002986:Clinical Trials as Topic; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology*; D009683:Nuclear Medicine / Q000379:methods / Q000639:trends; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011877:Radionuclide Imaging / Q000379:methods* / Q000639:trends*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology