Abstract
Over the past several decades, significant progress has been made in the pathohistological assessment of vulnerable plaques and in invasive intravascular imaging techniques. However, the assessment of plaque morphology by invasive modalities is of limited value for the detection of subclinical coronary atherosclerosis and the subsequent prediction or prevention of acute cardiovascular events. Recently, magnetic resonance (MR) imaging technology has reached a sufficient level of spatial resolution, which allowed the plaque visualization of large and static arteries such as the carotids and aorta. However, coronary wall imaging by MR is still challenging due to the small size of coronary arteries, cardiac and respiratory motion, and the low contrast-to-noise ratio between the coronary artery wall and the surrounding structures. Following the introduction of carotid plaque imaging with noncontrast T1-weighted imaging (T1WI), some investigators have reported that coronary artery high-intensity signals on T1WI are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although there are several limitations and issues that need to be resolved, this novel MR technique for coronary plaque imaging could influence treatment strategies for atherothrombotic disease and may be useful for understanding the pathophysiological mechanisms of atherothrombotic plaque formation.
Highlights
Acute myocardial infarction or sudden cardiac death frequently occurs as the first symptom of coronary diseases, without prodromal angina [1]
Over the past several decades, significant progress has been made in the assessment of vulnerable plaques using invasive intravascular imaging, such as intravascular ultrasound (IVUS) [8,9,10], coronary angioscopy [11,12], or optimal coherence tomography (OCT) [13,14,15]
We focus on the accumulated data on vulnerable plaque imaging using magnetic resonance (MR) techniques, and we introduce the results from our recent studies
Summary
Acute myocardial infarction or sudden cardiac death frequently occurs as the first symptom of coronary diseases, without prodromal angina [1]. Some investigators have reported that coronary artery HISs on T1WI are associated with a vulnerable plaque morphology [24,25,26,28] and an increased risk of future cardiac events [27]. Asaumi et al examined the relationship between HISs on T1WI and PCI-related myocardial injury, which is manifested by the elevation of cardiac troponin, in patients undergoing elective PCI [31] They reported that the optimal PMR cutoff value for predicting PCI-related myocardial injury was 1.3, and the sensitivity and specificity were 67% and 86%, respectively. Hoshi et al reported that in patients with stable angina pectoris undergoing elective PCI, the PMR cutoff value of 1.44 predicted PCI-related myocardial injury, and the sensitivity and specificity were 78% and 82%, respectively [32]. If statin therapy modifies plaque morphology and makes it more stable, and accelerates the degradation of methemoglobin, that could be invaluable for treatment strategies for atherosclerosis
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