Clinically available techniques for imaging features of plaque vulnerability
| Imaging technique | Clinical feasibility (cost, availability, ease of use, etc) | Key imaging targets | Comments |
|---|---|---|---|
| Non-invasive | |||
| Ultrasound | +++ | cIMT | Carotid imaging only. Conflicting evidence for use as surrogate end point in drug trials |
| CT | +++ | Calcification (macroscopic) Plaque volume/composition Remodelling | Widely available |
| MRI | ++ | Plaque volume/composition Neovascularisation and IPH Inflammation (USPIO) | Technically challenging to image coronary plaque |
| PET | + | Inflammation (18F-FDG) Microcalcification (18F-NaF) | Limited availability Short T1/2 of tracers necessitates close proximity of cyclotron |
| Invasive | |||
| Coronary angiography | +++ | Stenosis severity | Essential prerequisite to other invasive imaging tools Can be combined with FFR for assessing coronary physiology |
| IVUS | ++ | Plaque volume/composition Positive remodelling Calcification (macroscopic) | Prospective studies have demonstrated predictive potential |
| OCT | ++ | Fibrous cap thickness Plaque rupture Thrombus | Can differentiate plaque rupture from erosion |
| NIRS | + | Lipid core | Predictive of periprocedural MI Prospective validation study underway |
cIMT, carotid intima-media thickness; 18F-FDG, 18F-fluorodeoxyglucose; 18F-NaF, 18F-sodium fluoride; FFR, fractional flow reserve; IPH, intraplaque haemorrhage; IVUS, intravascular ultrasound; MI, myocardial infarction; NIRS, near-infrared spectroscopy; OCT, optical coherence tomography; PET, positron emission tomography; T1/2, half-life; USPIO, ultrasmall superparamagnetic iron oxide.