Cardiovascular magnetic resonance imaging of coronary atherothrombosis.

Abstract

Atherothrombosis, defined as atherosclerotic lesion disruption with superimposed thrombus formation, is the major cause of acute coronary syndromes and cardiovascular death. CMR imaging of coronary atherothrombosis is challenging because of the small caliber of the vessels combined with respiratory and cardiac motion. Freebreathing 3D CMR coronary vessel wall imaging has enabled in vivo quantification of coronary plaque burden and remodeling as a marker of subclinical CAD. Molecular imaging via novel target-specific contrast agents such as fibrin-binding agents to detect arterial thrombus shows great promise as the new frontier in noninvasive imaging. Advances in molecular imaging and CMR techniques offer the potential for direct imaging of coronary thrombosis and in-stent thrombosis by use of novel fibrin-binding molecular MR contrast agents. Although the current role of noninvasive CMR imaging of atherothrombosis remains investigational, these techniques should enhance our understanding of the natural history of acute coronary syndromes and thereby facilitate strategies to prevent acute coronary syndromes and cardiovascular death in vulnerable patients.