Currently available imaging modalities can delineate vascular wall anatomy. Oct imaging may more effectively detect vulnerable plaque. The invasive diagnosis and treatment of vulnerable coronary. Dowe, md atlantic medical imagingatlantic medical imaging. Vessel wall imaging has been increasingly used to characterize plaque beyond luminal narrowing to identify patients who may be at the highest risk of cerebrovascular. October 12, 2008 research results indicate that optical coherence tomography oct may be the best tool available to detect vulnerable plaque vp in coronary arteries, according to findings that will be presented at the 20th annual transcatheter cardiovascular therapeutics tct scientific symposium, sponsored by the cardiovascular research foundation crf. Atherosclerosis plaque imaging and characterization using magnetic resonance imaging. Primary to validate a commercial semiautomated computed tomography angiography cta software for vulnerable plaque detection compared to histology of carotid endarterectomy. N2 despite the remarkable advances in cardiovascular imaging over the last. A comparison showing the same lesions imaged with grayscale ivus left, and colorcoded virtual histology that characterizes the plaque.
Vulnerable atherosclerotic plaque imaging by small. Zaman, phd, instructor of cardiovascular medicine at stanford university. Various molecular imaging methods have been developed in cancer imaging to identify molecular characteristics of tumors. We discuss the recent advances in noninvasive and intravascular imaging that have significantly improved the ability to evaluate vulnerable plaque in vivo. Imaging the vulnerable plaque by ultrasound anthony n. Detection of coronary vulnerable plaque with contrast. Coronary artery, plaque imaging, computed tomography. The majority of patients with acute coronary syndromes acs present. Demaria, jagat narula, ehtisham mahmud, sotirios tsimikas recent intravascular ultrasound ivus studies have suggested that. Several invasive imaging technologies claim to detect vp, and while the link between. Sadeghi mm1, glover dk, lanza gm, fayad za, johnson ll. A definition of an ivusderived tcfa idtcfa has been proposed to evaluate the in vivo incidence of vulnerable plaque when using vhivus imaging that closely matches ex vivo pathological. The landmark prospect study has confirmed two key principles that will be relevant as we. Oct was developed for crosssectional imaging in biological systems.
Identification of vulnerable plaques cardiac interventions today. Complications of vulnerable atherosclerotic plaques rupture, luminal and mural thrombosis, intraplaque hemorrhage, rapid progression to stenosis, spasm, and so forth lead to heart. Duplex ultrasound imaging is well established to assess the degree of carotid stenosis. Cardiovascular imaging for detection of vulnerable plaques. Despite the remarkable advances in cardiovascular imaging over the last decade, it is still challenging to identify highrisk atherosclerotic plaques prior to onset of major cardiovascular. There is considerable interest in being able to clearly identify vulnerable plaque vp and research efforts are intensifying. Primary to validate a commercial semiautomated computed tomography angiography cta software. Noninvasive imaging of vulnerable plaque morphology has been. Vulnerable plaque imaging in vivo plaque size large core macrophages thin cap carotid ultrasound, ct, mri. Carotid vessel wall imaging on cta american journal of. Previous studies also demonstrated the ability of mri to visualize the coronary vessel wall.
The everlasting quest for the vulnerable plaque american. Detection and treatment of vulnerable plaques and vulnerable. Thermography, vulnerability index program 2, natural history for coronary events. Assessment of coronary nearinfrared spectroscopy imaging to detect vulnerable plaques and. Early detection and treatment of the vulnerable coronary. Rotablator trademark is not owned by infraredx, a nipro company and is attributed to the company. Oct uses lowcoherence interferometry to generate a 2dimensional image of optical scattering with ultrahigh resolution 4 to 20. Within any given patient, different types of potential vulnerable plaques vps with various underlying histopathology and biology exist. Atherosclerosis imaging and analysis vpdiagnostics. Vulnerable plaque may be easier to detect through new imaging technology.
Ivus radiofrequency signal data for the regions of interest roi are processed by calculating a mathematical autoregressive model for. Coronary plaque thrombosis is found in most patients dying of cardiovascular death. Nirs imaging of nonobstructive territories in patients undergoing cardiac catheterisation and possible percutaneous coronary intervention was safe and can aid in identifying patients and segments at. Intracoronary imaging for detecting vulnerable plaque. Three vessel ivus imaging in 24 pts with acs and positive tn 50 ruptured plaques 9 culprit lesion 41 nonculprit lesion 19 pts had at least 1 nonculprit plaque rupture 79% 17 pts had 1 plaque rupture in. In contrast to vulnerable plaques in the coronary arteries, highrisk plaques in the carotid arteries are severely stenotic. Atherosclerotic plaque formed in vessel walls may cause ischemia, and the rupture of vulnerable plaque may result in fatal events, like myocardial infarction or stroke. October 12, 2008 research results indicate that optical coherence tomography oct may be the best tool available to detect vulnerable plaque vp in coronary arteries, according to findings that will be.
Pet imaging of atherosclerosis reveals risk of plaque rupture. Each coronary plaque was segmented blinded to other imaging modality results using a semiautomated software tool qangioct research edition. These methods can be applied to vulnerable plaque, which has similar. We have developed software to quantify the amount of necrotic core in contact with the lumen, enabling the. Detection of vulnerable coronary artery plaques jacc. Identification of invasive and radionuclide imaging. Coronary luminal thrombosis occurs from 3 different pathologies plaque rupture, plaque erosion, and calcified nodules, with plaque rupture being the most common 11.
However, there is clear evidence, that not only the degree of luminal narrowing but also plaque morphology and plaque. Correlation of carotid artery atherosclerotic lesion. Wall thickening and atherosclerotic plaque components can be visualized in the carotid arteries and the aorta. The term vulnerable plaque has been established as a nomenclature to describe the instability of the plaque at a high risk of disruption, leading to. Vulnerable plaque formation and ruptureinsights from imaging. Acute myocardial infarction and sudden cardiac death are the first manifestations of coronary artery disease in most patients.
Vulnerable plaque may be easier to detect through new. Nuclear molecular imaging for vulnerable atherosclerotic. Multimodality imaging to detect vulnerable plaque in. Imaging vulnerable plaque by ultrasound sciencedirect. Pet imaging of atherosclerosis reveals risk of plaque. Phdfrom the british heart foundationuniversity centre. These include diffusionweighted imaging, which pictures the various water diffusion coefficients in the plaque, and gadofluorineenhanced imaging, which can be used either as a blood pool agent to detect. Multimodality imaging to detect vulnerable plaque in coronary. Identification of patients and plaques vulnerable to. Noninvasive technique for imaging the vulnerable plaque multidetector computed tomography over the past 10 years, technical improvementsincluding faster gantry rotation, increased number of detectors, decreased slice thickness, and use of dual xray sourceshave considerably increased the temporal and the spatial resolution of multidetector computed tomography mdct 99. June 26th, 2012 ge healthcare and vpdiagnostics collaborate on mri of carotid artery atherosclerosis new collaboration aims to.
This is the first clinical imaging system able to detect vulnerable plaque in their earliest stages, said raiyan t. Imaging vulnerable plaque by ultrasound article in journal of the american college of cardiology 478 suppl. The prospect study an imaging study in patients with unstable atherosclerotic lesions revealed that identifying 596 highrisk plaques. The clinical utility of hybrid imaging for the identification of. Arithmetic of vulnerable plaques for noninvasive imaging. Retrospective autopsy studies reported that the most common histopathological finding associated with plaque rupture was thincap. Intravascular imaging of vulnerable coronary plaque. Noninvasive imaging of vulnerable plaque morphology has been extensively. Noninvasive methods to image vulnerable plaques in the carotid arteries. The term vulnerable plaque has been established as a nomenclature to describe the instability of the plaque at a high risk of disruption, leading to thrombosis and rapid stenosis progression 2, 3, 4. Investigators used grayscale ivus and volcano corporations virtual histology vhivus tissue characterization software to evaluate suspected vulnerable plaques in the coronary arteries. The impact of early vulnerable plaque detection and therapy would be a major breakthrough in the management of patients with coronary, peripheral and neurovascular disease. Precise metrics of typical vulnerable atherosclerotic plaque dimensions will need to be defined to facilitate their identification by noninvasive imaging modalities.
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