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(Circulation. 2002;106:2026.)
© 2002 American Heart Association, Inc.

Current Perspective

Computed Tomography and Magnetic Resonance Imaging for Noninvasive Coronary Angiography and Plaque Imaging

Current and Potential Future Concepts

Zahi A. Fayad, PhD; Valentin Fuster, MD, PhD; Konstantin Nikolaou, MD; Christoph Becker, MD

From The Zena and Michael A. Wiener Cardiovascular Institute (Z.A.F., V.F.), New York, NY; the Department of Radiology (Z.A.F.), Mount Sinai School of Medicine, New York, NY; and the Department of Clinical Radiology (K.N., C.B.), Klinikum Grosshadern, University of Munich, Munich, Germany.

Correspondence to Zahi Fayad, PhD, Imaging Science Laboratories, Mount Sinai School of Medicine, Box 1030, New York, NY 10029. E-mail zahi.fayad@mssm.edu

Key Words: imaging • plaque • angiography • magnetic resonance imaging • computed tomography

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Atherothrombosis is a systemic disease of the vessel wall that causes distinct clinical manifestations, depending on the affected circulatory bed and the characteristics of the individual lesions.¹ These lesions may be quite heterogeneous.¹ Thus, the clinical manifestations of atherothrombosis of the coronary arteries, of the arteries supplying the central nervous system, of the aorta, and of the peripheral circulation can be significantly different.

Disruption-prone plaques in the coronary arteries, the so-called "vulnerable plaques," tend to have a thin fibrous cap (cap thickness 65 to 150 µm) and a large lipid core (American Heart Association [AHA] plaque type IV-Va). Acute coronary syndromes often result from disruption of a modestly stenotic vulnerable plaque, not visible by x-ray angiography, which results in a thrombotic complication (AHA plaque type VI). During its evolution, a type Va plaque may also become fibrotic (AHA plaque type Vc) or calcified (AHA plaque type Vb).^2,3 In contrast to coronary artery vulnerable plaques characterized by high lipid content and a thin fibrous cap, high-risk plaques of the carotid arteries tend to be fibrotic and severely stenotic.³

Imaging of Atherothrombotic Disease
Because there is striking heterogeneity in the composition of human atherothrombotic plaques, even within the same individual, reliable noninvasive imaging tools that can detect early atherothrombotic disease in the various regions and characterize the composition of the plaques are clinically desirable.³ Such imaging tools would improve our understanding of the pathophysiological mechanisms underlying atherothrombotic processes and allow us to better risk-stratify the disease. Additionally, such tools may permit optimal tailoring of treatment and . . . [Full Text of this Article]

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