Nature Reviews Cardiology 7, 165-173 (March 2010) | doi:10.1038/nrcardio.2009.246

Subject Category: Vascular disease

Article series: Molecular Imaging

MRI of carotid atherosclerosis: clinical implications and future directions

Hunter R. Underhill, Thomas S. Hatsukami, Zahi A. Fayad, Valentin Fuster & Chun Yuan  About the authors


Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood flow, and inflammation. Despite recent advances in understanding of plaque biology, diagnosis, and treatment, atherosclerosis remains a leading cause of morbidity and mortality. Further research into the development and validation of reliable indicators of the high-risk individual is greatly needed. Carotid MRI is a histologically validated, noninvasive imaging method that can track disease progression and regression, and quantitatively evaluate a spectrum of parameters associated with in vivo plaque morphology and composition. Intraplaque hemorrhage and the lipid-rich necrotic core are the best indicators of lesion severity currently visualized by carotid MRI. However, MRI methods capable of imaging other important aspects of carotid atherosclerotic disease in vivo—including inflammation, neovascularization, and mechanical forces—are emerging and may aid in advancing our understanding of the pathophysiology of this multifactorial disease.

Author affiliations

H. R. Underhill, T. S. Hatsukami, Z. A. Fayad, V. Fuster & C. Yuan
Department of Radiology, University of Washington, 815 Mercer Street, Box 358050, Seattle, WA 98109, USA (H. R. Underhill, C. Yuan).  Department of Surgery, University of Washington, 815 Mercer Street, Box 358050, Seattle, WA 98109, USA (T. S. Hatsukami).  The Translational and Molecular Imaging Institute, Eva and Morris Feld Imaging Science Laboratories, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1234, New York, NY 10029, USA (Z. A. Fayad).  The Centro Nacional de Investigaciones Cardiovasculares (CNIC), Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Melchor Fernández Almagro, 3, Madrid E-28029, Spain (V. Fuster).

Correspondence to: H. R. Underhill

Published online 26 January 2010