Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Imaging atherosclerotic plaque inflammation

Nature Clinical Practice Cardiovascular Medicine volume 5, pages S11–S17 (2008)Cite this article

Abstract

Inflammation within atherosclerotic plaques is one of the main drivers of atherosclerotic plaque rupture, which frequently leads to clinical events such as myocardial infarction and stroke. Current gold standard techniques such as X-ray angiography and ultrasound can rapidly report on luminal encroachment but give no readout on inflammatory state of the plaque. We summarize several alternative imaging techniques—CT, MRI, and nuclear imaging—that are close to the clinical arena, and we provide the relative advantages of each.

Key Points

  • Inflammation within atherosclerotic plaques is the main force behind plaque rupture and clinical events

  • There is no perfect imaging technique; each modality has advantages and disadvantages in terms of resolution, sensitivity, and radiation exposure

  • MRI, CT, and nuclear imaging techniques can quantify the level of inflammation within atherosclerotic plaques

  • Long-term, prospective, clinical outcome studies are required to prove the capacity of imaging to predict those patients who will have events in the future

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: In vivo magnetic resonance images obtained at baseline and at 1 h and 24 h postinjection of immunomicelles in ApoE−/− mice (which are prone to atherosclerotic plaques).
Figure 2: Imaging of an atherosclerotic plaque in the aorta of a rabbit.
Figure 3: Effects of simvastatin on the uptake of [18F]-FDG in atherosclerotic plaque inflammation.

Similar content being viewed by others

References

  1. Davies MJ (1996) Stability and instability: two faces of coronary atherosclerosis. Circulation 94: 2013–2020

    Article  CAS  Google Scholar 

  2. Davies MJ (1995) Acute coronary thrombosis—the role of plaque disruption and its initiation and prevention. Eur Heart J 16 (Suppl L): S3–S7

    Article  Google Scholar 

  3. Jaffer FA et al. (2007) Molecular imaging of cardiovascular disease. Circulation 116: 1052–1061

    Article  Google Scholar 

  4. Wu JC et al. (2007) Cardiovascular molecular imaging. Radiology 244: 337–355

    Article  Google Scholar 

  5. Fayad ZA and Fuster V (2001) The human high-risk plaque and its detection by magnetic resonance imaging. Am J Cardiol 88 (Suppl 1): 42E–45E

    Article  CAS  Google Scholar 

  6. Itskovich V et al. (2004) Quantification of human atherosclerotic plaques using spatially enhanced cluster analysis of multicontrast-weighted magnetic resonance images. Magn Reson Med 52: 515–523

    Article  Google Scholar 

  7. Yuan C et al. (2002) Identification of fibrous cap rupture with magnetic resonance imaging is highly associated with recent transient ischemic attack or stroke. Circulation 105: 181–185

    Article  Google Scholar 

  8. Yuan C et al. (2001) In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. Circulation 104: 2051–2056

    Article  CAS  Google Scholar 

  9. Tang TY et al. (2008) Correlation of carotid atheromatous plaque inflammation with biomechanical stress: utility of USPIO enhanced MR imaging and finite element analysis. Atherosclerosis 196: 879–887

    Article  CAS  Google Scholar 

  10. Trivedi RA et al. (2006) Identifying inflamed carotid plaques using in vivo USPIO-enhanced MR imaging to label plaque macrophages. Arterioscler Thromb Vasc Biol 26: 1601–1606

    Article  CAS  Google Scholar 

  11. Trivedi RA et al. (2004) In vivo detection of macrophages in human carotid atheroma: temporal dependence of ultrasmall superparamagnetic particles of iron oxide-enhanced MRI. Stroke 35: 1631–1635

    Article  Google Scholar 

  12. Trivedi R et al. (2003) Accumulation of ultrasmall superparamagnetic particles of iron oxide in human atherosclerotic plaque. Circulation 108: e140

    Article  Google Scholar 

  13. Rioufol G et al. (2002) Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Circulation 106: 804–808

    Article  CAS  Google Scholar 

  14. Buffon A et al. (2002) Widespread coronary inflammation in unstable angina. N Engl J Med 347: 5–12

    Article  Google Scholar 

  15. Smith BR et al. (2007) Localization to atherosclerotic plaque and biodistribution of biochemically derivatized superparamagnetic iron oxide nanoparticles (SPIONs) contrast particles for magnetic resonance imaging (MRI). Biomed Microdev 9: 719–727

    Article  Google Scholar 

  16. Amirbekian V et al. (2007) Detecting and assessing macrophages in vivo to evaluate atherosclerosis noninvasively using molecular MRI. Proc Natl Acad Sci USA 104: 961–966

    Article  CAS  Google Scholar 

  17. Weustink AC et al. (2007) Reliable high-speed coronary computed tomography in symptomatic patients. J Am Coll Cardiol 50: 786–794

    Article  Google Scholar 

  18. Pohle K et al (2007) Characterization of non-calcified coronary atherosclerotic plaque by multi-detector row CT: comparison to IVUS. Atherosclerosis 190: 174–180

    Article  CAS  Google Scholar 

  19. Carrascosa PM et al. (2006) Characterization of coronary atherosclerotic plaques by multidetector computed tomography. Am J Cardiol 97: 598–602

    Article  Google Scholar 

  20. Leber AW et al. (2004) Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol 43: 1241–1247

    Article  Google Scholar 

  21. Hoffmann U et al. (2006) Noninvasive assessment of plaque morphology and composition in culprit and stable lesions in acute coronary syndrome and stable lesions in stable angina by multidetector computed tomography. J Am Coll Cardiol 47: 1655–1662

    Article  Google Scholar 

  22. Leber AW et al. (2003) Composition of coronary atherosclerotic plaques in patients with acute myocardial infarction and stable angina pectoris determined by contrast-enhanced multislice computed tomography. Am J Cardiol 91: 714–718

    Article  Google Scholar 

  23. Hyafil F et al. (2007) Noninvasive detection of macrophages using a nanoparticulate contrast agent for computed tomography. Nat Med 13: 636–641

    Article  CAS  Google Scholar 

  24. Shankar LK et al. (2006) Consensus recommendations for the use of 18F-FDG PET as an indicator of therapeutic response in patients in National Cancer Institute Trials. J Nucl Med 47: 1059–1066

    CAS  PubMed  Google Scholar 

  25. Weber WA and Figlin R (2007) Monitoring cancer treatment with PET/CT: does it make a difference? J Nucl Med 48 (Suppl 1): S36–S44

    Google Scholar 

  26. Rudd JH et al. (2002) Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation 105: 2708–2711

    Article  CAS  Google Scholar 

  27. Stefanadis C et al. (2001) Increased local temperature in human coronary atherosclerotic plaques: an independent predictor of clinical outcome in patients undergoing a percutaneous coronary intervention. J Am Coll Cardiol 37: 1277–1283

    Article  CAS  Google Scholar 

  28. Tawakol A et al. (2006) In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients. J Am Coll Cardiol 48: 1818–1824

    Article  Google Scholar 

  29. Dunphy MP et al. (2005) Association of vascular 18F-FDG uptake with vascular calcification. J Nucl Med 46: 1278–1284

    PubMed  Google Scholar 

  30. Davies JR et al. (2005) Identification of culprit lesions after transient ischemic attack by combined 18F fluorodeoxyglucose positron-emission tomography and high-resolution magnetic resonance imaging. Stroke 36: 2642–2647

    Article  Google Scholar 

  31. Tahara N et al. (2006) Simvastatin attenuates plaque inflammation: evaluation by fluorodeoxyglucose positron emission tomography. J Am Coll Cardiol 48: 1825–1831

    Article  CAS  Google Scholar 

  32. Virmani R et al. (2006) Histopathology of carotid atherosclerotic disease. Neurosurgery 59 (Suppl 3): S219–S227

    PubMed  Google Scholar 

  33. Ishino S et al. (2007) 99mTc-Annexin A5 for noninvasive characterization of atherosclerotic lesions: imaging and histological studies in myocardial infarction-prone Watanabe heritable hyperlipidemic rabbits. Eur J Nucl Med Mol Imaging 34: 889–899

    Article  Google Scholar 

  34. Johnson LL et al. (2005) 99mTc-annexin V imaging for in vivo detection of atherosclerotic lesions in porcine coronary arteries. J Nucl Med 46: 1186–1193

    PubMed  Google Scholar 

  35. Isobe S et al. (2006) Noninvasive imaging of atherosclerotic lesions in apolipoprotein E-deficient and low-density-lipoprotein receptor-deficient mice with annexin A5. J Nucl Med 47: 1497–1505

    CAS  PubMed  Google Scholar 

  36. Kietselaer BL et al. (2004) Noninvasive detection of plaque instability with use of radiolabeled annexin A5 in patients with carotid-artery atherosclerosis. N Engl J Med 350: 1472–1473

    Article  CAS  Google Scholar 

  37. Hartung D et al. (2005) Resolution of apoptosis in atherosclerotic plaque by dietary modification and statin therapy. J Nucl Med 46: 2051–2056

    CAS  PubMed  Google Scholar 

  38. Sarda-Mantel L et al. (2006) 99mTc-annexin-V functional imaging of luminal thrombus activity in abdominal aortic aneurysms. Arterioscler Thromb Vasc Biol 26: 2153–2159

    Article  CAS  Google Scholar 

  39. Galis ZS et al. (1994) Increased expression of matrix metalloproteinases and matrix degrading activity in vulnerable regions of human atherosclerotic plaques. J Clin Invest 94: 2493–2503

    Article  CAS  Google Scholar 

  40. Luan Z et al. (2003) Statins inhibit secretion of metalloproteinases-1, -2, -3, and -9 from vascular smooth muscle cells and macrophages. Arterioscler Thromb Vasc Biol 23: 769–775

    Article  CAS  Google Scholar 

  41. Schafers M et al. (2004) Scintigraphic imaging of matrix metalloproteinase activity in the arterial wall in vivo. Circulation 109: 2554–2559

    Article  Google Scholar 

  42. Breyholz HJ et al. (2007) A 18F-radiolabeled analogue of CGS 27023A as a potential agent for assessment of matrix-metalloproteinase activity in vivo. Q J Nucl Med Mol Imaging 51: 24–32

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. JHF Rudd is a Clinical Lecturer in Cardiovascular Medicine at Cambridge University and a Specialist Registrar at Addenbrooke's Hospital, Cambridge, UK,

    James HF Rudd

  2. ZA Fayad is Professor of Radiology and Medicine (Cardiology) at Mount Sinai School of Medicine, New York, NY, USA.,

    Zahi A Fayad

Authors
  1. James HF Rudd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zahi A Fayad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James HF Rudd.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rudd, J., Fayad, Z. Imaging atherosclerotic plaque inflammation. Nat Rev Cardiol 5 (Suppl 2), S11–S17 (2008). https://doi.org/10.1038/ncpcardio1160

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpcardio1160

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing