Imaging Plaque Inflammation in Higher-Risk Patients: What Do We Know and What Are We Looking For?
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NOVEL + EMERGING RISK FACTORS (K NASIR, SECTION EDITOR)
Imaging Plaque Inflammation in Higher-Risk Patients: What Do We Know and What Are We Looking For? Amorina Ishai 1 & Ahmed Tawakol 1,2
Published online: 30 April 2015 # Springer Science+Business Media New York 2015
Abstract Atherosclerosis is a chronic inflammatory condition complicating cholesterol accumulation within the artery wall. Inflammation is believed to play an important role in the formation, progression, and ultimately the rupture of atherosclerotic plaques (the principle event leading to most myocardial infarctions and strokes). An enhanced understanding of the inflammatory process within the atheroma may therefore facilitate risk stratification and treatment strategies. Molecular imaging techniques such as PET/CT have the ability to quantify arterial inflammation and assess the high-risk features of atheromas thus may be useful for identifying patients who are at higher risk for an atherothrombotic event. In this review, we focus on the potential of FDG-PET/CT as a tool to measure arterial inflammation, enhance risk stratification, and to evaluate novel therapies directed against atherosclerotic disease. Additionally, this review will provide a discussion on current challenges as well as future directions.
Keywords FDG-PET . Inflammation . Atherosclerosis
This article is part of the Topical Collection on Novel and Emerging Risk Factors * Ahmed Tawakol [email protected] 1
Cardiac MR PET CT Program, Department of Imaging, Massachusetts General Hospital and Harvard Medical School Boston, 165 Cambridge Street, Suite 400, Boston, MA 02114-2750, USA
2
Cardiology Division, Massachusetts General Hospital and Harvard Medical School Boston, 165 Cambridge Street, Suite 400, Boston, MA 02114-2750, USA
Introduction Atherosclerosis and its complications are the primary causes of cardiovascular morbidity and mortality worldwide [1]. The formation and development of an atherosclerotic lesion is a complex process that includes chronic inflammation as a central pathologic component [2]. Monocyte-derived macrophages play a key role both in the incipient phases of plaque formation as well as in the progression of mature plaques [3, 4]. Imaging modalities such as conventional angiography, ultra sonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) provide clinically useful information on plaque structure or luminal narrowing [5–7]. However, this structural data provides an incomplete assessment of atherothrombotic risk, in part, since stenosis is only a modest predictor of future complications as most acute coronary events occur at sites of mild to moderate obstruction [8, 9•]. The evaluation of the arterial wall inflammation, in addition to assessment of structure and narrowing may therefore provide clinically important insights. Such structural and biological imaging can be achieved via combined PET/CT or PET/MR imaging.
Inflammation and Atherosclerosis The development of atherosclerotic lesions is a complex process, with chro
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