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Imaging of atherosclerotic cardiovascular disease


Atherosclerosis is characterized by thickening of the walls of the arteries, a process that occurs slowly and 'silently' over decades. This prolonged course of disease provides a window of opportunity for diagnosis before symptoms occur. But, until recently, only advanced atherosclerotic disease could be observed. Now, developments in imaging technology offer many enticing prospects, including detecting atherosclerosis early, grouping individuals by the probability that they will develop symptoms of atherosclerosis, assessing the results of treatment and improving the current understanding of the biology of atherosclerosis.

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Figure 1: The development of an atherosclerotic lesion.
Figure 2: Multimodal imaging of inflammation and atherosclerosis.


  1. 1

    Lusis, A. J. Atherosclerosis. Nature 407, 233–241 (2000).

    CAS  Article  Google Scholar 

  2. 2

    Gershlick, A. H. et al. Role of non-invasive imaging in the management of coronary artery disease: an assessment of likely change over the next 10 years. A report from the British Cardiovascular Society Working Group. Heart 93, 423–431 (2007).

    CAS  Article  Google Scholar 

  3. 3

    Hendel, R. C. et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J. Am. Coll. Cardiol. 48, 1475–1497 (2006).

    Article  Google Scholar 

  4. 4

    Sakuma, H. Magnetic resonance imaging for ischemic heart disease. J. Magn. Reson. Imaging 26, 3–13 (2007).

    Article  Google Scholar 

  5. 5

    Kwong, R. Y. et al. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 113, 2733–2743 (2006).

    Article  Google Scholar 

  6. 6

    Ibanez, B. et al. Early metoprolol administration before coronary reperfusion results in increased myocardial salvage: analysis of ischemic myocardium at risk using cardiac magnetic resonance. Circulation 115, 2909–2916 (2007).

    CAS  Article  Google Scholar 

  7. 7

    Fenchel, M. et al. Atherosclerotic disease: whole-body cardiovascular imaging with MR system with 32 receiver channels and total-body surface coil technology — initial clinical results. Radiology 238, 280–291 (2006).

    Article  Google Scholar 

  8. 8

    Hamon, M. et al. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. J. Am. Coll. Cardiol. 48, 1896–1910 (2006).

    Article  Google Scholar 

  9. 9

    Budoff, M. J. et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation 114, 1761–1791 (2006).

    Article  Google Scholar 

  10. 10

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

    Article  Google Scholar 

  11. 11

    MacNeill, B. D., Lowe, H. C., Takano, M., Fuster, V. & Jang, I.-K. Intravascular modalities for detection of vulnerable plaque: current status. Arterioscler. Thromb. Vasc. Biol. 23, 1333–1342 (2003).

    CAS  Article  Google Scholar 

  12. 12

    Lorenz, M. W., Markus, H. S., Bots, M. L., Rosvall, M. & Sitzer, M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 115, 459–467 (2007).

    Article  Google Scholar 

  13. 13

    Greenland, P. et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation 115, 402–426 (2007).

    Article  Google Scholar 

  14. 14

    Naghavi, M. et al. From vulnerable plaque to vulnerable patient — part III: executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am. J. Cardiol. 98, 2H–15H (2006).

    Article  Google Scholar 

  15. 15

    Clouse, M. E. et al. How useful is computed tomography for screening for coronary artery disease? Circulation 113, 125–146 (2006).

    Article  Google Scholar 

  16. 16

    Min, J. K. et al. Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality. J. Am. Coll. Cardiol. 50, 1161–1170 (2007).

    Article  Google Scholar 

  17. 17

    Cordeiro, M. A. & Lima, J. A. Atherosclerotic plaque characterization by multidetector row computed tomography angiography. J. Am. Coll. Cardiol. 47, C40–C47 (2006).

    Article  Google Scholar 

  18. 18

    Khera, A. et al. Relationship between C-reactive protein and subclinical atherosclerosis: the Dallas Heart Study. Circulation 113, 38–43 (2006).

    CAS  Article  Google Scholar 

  19. 19

    Corti, R. et al. Effects of aggressive versus conventional lipid-lowering therapy by simvastatin on human atherosclerotic lesions: a prospective, randomized, double-blind trial with high-resolution magnetic resonance imaging. J. Am. Coll. Cardiol. 46, 106–112 (2005).

    CAS  Article  Google Scholar 

  20. 20

    Naghavi, M. et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part I. Circulation 108, 1664–1672 (2003).

    Article  Google Scholar 

  21. 21

    Saam, T. et al. The vulnerable, or high-risk, atherosclerotic plaque: noninvasive MR imaging for characterization and assessment. Radiology 244, 64–77 (2007).

    Article  Google Scholar 

  22. 22

    Briley-Saebo, K. C. et al. Magnetic resonance imaging of vulnerable atherosclerotic plaques: current imaging strategies and molecular imaging probes. J. Magn. Reson. Imaging 26, 460–479 (2007).

    Article  Google Scholar 

  23. 23

    Takaya, N. et al. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI — initial results. Stroke 37, 818–823 (2006).

    Article  Google Scholar 

  24. 24

    Choudhury, R. P., Fuster, V. & Fayad, Z. A. Molecular, cellular and functional imaging of atherothrombosis. Nature Rev. Drug Discov. 3, 913–925 (2004). This review discusses different techniques for imaging the blood vessel wall, focusing on molecular imaging.

    CAS  Article  Google Scholar 

  25. 25

    Wu, J. C., Bengel, F. M. & Gambhir, S. S. Cardiovascular molecular imaging. Radiology 244, 337–355 (2007).

    Article  Google Scholar 

  26. 26

    Jaffer, F. A., Libby, P. & Weissleder, R. Molecular imaging of cardiovascular disease. Circulation 116, 1052–1061 (2007). This is an up-to-date review of cardiovascular molecular imaging, including a discussion of contrast agents that are in clinical testing.

    Article  Google Scholar 

  27. 27

    Wickline, S. A., Neubauer, A. M., Winter, P. M., Caruthers, S. D. & Lanza, G. M. Molecular imaging and therapy of atherosclerosis with targeted nanoparticles. J. Magn. Reson. Imaging 25, 667–680 (2007).

    Article  Google Scholar 

  28. 28

    Sosnovik, D. E., Nahrendorf, M. & Weissleder, R. Molecular magnetic resonance imaging in cardiovascular medicine. Circulation 115, 2076–2086 (2007).

    Article  Google Scholar 

  29. 29

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

    CAS  Article  Google Scholar 

  30. 30

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

    ADS  CAS  Article  Google Scholar 

  31. 31

    Hyafil, F. et al. Noninvasive detection of macrophages using a nanoparticulate contrast agent for computed tomography. Nature Med. 13, 636–641 (2007). This paper was the first to show selective visualization of macrophages by using CT.

    CAS  Article  Google Scholar 

  32. 32

    Tawakol, A. et al. In vivo18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients. J. Am. Coll. Cardiol. 48, 1818–1824 (2006).

    Article  Google Scholar 

  33. 33

    Rudd, J. H. et al. 18Fluorodeoxyglucose positron emission tomography imaging of atherosclerotic plaque inflammation is highly reproducible: implications for atherosclerosis therapy trials. J. Am. Coll. Cardiol. 50, 892–896 (2007). This paper validates the reproducibility of concurrent PET and CT for the imaging of vascular inflammation.

    Article  Google Scholar 

  34. 34

    Sirol, M. et al. Chronic thrombus detection with in vivo magnetic resonance imaging and a fibrin-targeted contrast agent. Circulation 112, 1594–1600 (2005).

    Article  Google Scholar 

  35. 35

    Nahrendorf, M. et al. Noninvasive vascular cell adhesion molecule-1 imaging identifies inflammatory activation of cells in atherosclerosis. Circulation 114, 1504–1511 (2006).

    CAS  Article  Google Scholar 

  36. 36

    Villanueva, F. S. et al. Myocardial ischemic memory imaging with molecular echocardiography. Circulation 115, 345–352 (2007).

    Article  Google Scholar 

  37. 37

    Jaffer, F. A. et al. Optical visualization of cathepsin K activity in atherosclerosis with a novel, protease-activatable fluorescence sensor. Circulation 115, 2292–2298 (2007).

    CAS  Article  Google Scholar 

  38. 38

    Winter, P. M. et al. Endothelial αVβ3 integrin-targeted fumagillin nanoparticles inhibit angiogenesis in atherosclerosis. Arterioscler. Thromb. Vasc. Biol. 26, 2103–2109 (2006).

    CAS  Article  Google Scholar 

  39. 39

    Beeres, S. L. et al. Role of imaging in cardiac stem cell therapy. J. Am. Coll. Cardiol. 49, 1137–1148 (2007).

    Article  Google Scholar 

  40. 40

    Flaumenhaft, R. et al. Localization and quantification of platelet-rich thrombi in large blood vessels with near-infrared fluorescence imaging. Circulation 115, 84–93 (2007).

    Article  Google Scholar 

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This work was partly funded by the National Institutes of Health and the National Heart, Lung, and Blood Institute.

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The authors declare no competing financial interests.

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Correspondence should be addressed to Z.A.F. (

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Sanz, J., Fayad, Z. Imaging of atherosclerotic cardiovascular disease. Nature 451, 953–957 (2008).

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