title: Non-invasive molecular imaging of vulnerable atherosclerotic plaques.
abstract: The growing discoveries coming from clinical and basic research during the past decades have revolutionized our knowledge regarding pathophysiologic mechanisms underlying the atherosclerotic process and its thrombotic complications. The traditional view focusing on the severity of stenosis of atherosclerotic plaque has given way to the evidence that the clinical complications of atherosclerotic vascular disease, particularly the propensity to develop thrombotic complications, are determined mainly by the biological composition of the plaque. This paradigm shift has reinforced the need to move from the sole anatomical assessment toward combined anatomic and functional imaging modalities enabling the molecular and cellular characterization of the disease on top of its structural properties. Together, the progress to identify molecular targets related to plaque vulnerability and the improvement of imaging techniques for the detection of such molecular targets have allowed us to obtain new important pathophysiological information. This might allow better patient stratification for the identification of subjects at high risk to develop premature atherosclerosis who might need an aggressive therapeutic approach. Nuclear techniques, magnetic resonance imaging, computed tomography angiography, and contrast-enhanced ultrasound represent the currently available non-invasive imaging modalities for molecular imaging which can provide different and complementary insights into the biological features of the atherosclerotic process. This clinical review will discuss the evidence and potential translational applications of the individual imaging techniques particularly concerning their ability to detect the main atherosclerotic features related to plaque vulnerability, such as plaque inflammation and intertwined neovascularization.
authors.affiliation: Università Vita-Salute San Raffaele and Department of Cardiothoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy; Heart Care Foundation, Florence, Italy. Electronic address: magnoni.marco@tiscali.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Magnoni
authors.affiliation: Università Vita-Salute San Raffaele and Department of Cardiothoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy; Cardiovascular and Thoracic Department, AO Niguarda Ca' Granda, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ammirati
authors.affiliation: Università Vita-Salute San Raffaele and Department of Cardiothoracic and Vascular Diseases, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Camici
mesh_terms: D050197:Atherosclerosis / Q000175:diagnosis*; D003287:Contrast Media; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D057054:Molecular Imaging / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000175:diagnosis*
chemical_list: D003287:Contrast Media
keywords: Atherosclerosis; Computed tomography; Contrast-enhanced ultrasound; Magnetic resonance imaging; Positron emission tomography; Vasa vasorum