Abstract
The goal of this article is to illustrate the main invasive and noninvasive diagnostic modalities to image the vulnerable coronary plaque, which is responsible for acute coronary syndrome. The main epidemiologic and histological issues are briefly discussed in order to provide an adequate background. Comprehensive coronary atherosclerosis imaging should involve visualization of the entire coronary artery tree and plaque characterization, including three-dimensional morphology, relationship with the lumen, composition, vascular remodelling and presence of inflammation. No single technique provides such a comprehensive description, and no available modality extensively identifies the vulnerable plaque. In particular, we describe multislice computed tomography, which at present seems to be the most promising noninvasive tool for an exhaustive image-based quantification of coronary atherosclerosis.
Riassunto
Con questo articolo si vogliono illustrare le principali metodiche di imaging invasivo e non invasivo, che si prefiggono di identificare la placca vulnerabile coronarica, responsabile delle sindromi coronariche acute. Sono stati brevemente analizzati gli aspetti epidemiologici ed anatomo-patologici di maggiore rilievo allo scopo di fornire un adeguato background culturale. Un imaging onnicomprensivo della malattia aterosclerotica coronarica dovrebbe essere in grado di visualizzare l’intero albero coronarico e caratterizzare la placca nei suoi vari aspetti quali la morfologia tridimensionale, il rapporto con il lume, la composizione tessutale, il rimodellamento vascolare e la presenza di infiammazione. Nessuna tecnica riesce singolarmente a fornire un quadro talmente completo e nessuna modalità disponibile identifica in modo inequivocabile la placca vulnerabile. Particolare attenzione è stata rivolta alla tomografia computerizzata multistrato, che sembra, al momento, la tecnica piú promettente nel panorama delle metodiche non invasive per la quantificazione complessiva per immagini della malattia aterosclerotica coronarica.
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References/Bibliografia
Stary HC, Chandler AB, Glagov S et al (1994) A definition of initial, fatty streak, and intermediate lesions of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 89:2462–2478
Stary HC, Chandler AB, Dinsmore RE et al (1995) A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation 92:1355–1374
Fuster V, Badimon L, Badimon JJ et al (1992) The pathogenesis of coronary artery disease and the acute coronary syndromes (1). N Engl J Med 326:242–250
Fuster V, Badimon L, Badimon JJ et al (1992) The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med 326:310–318
Yusuf S, Reddy S, Ounpuu S et al (2001) Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 104:2746–2753
Heart disease and stroke statistics (2005) 2005 update. American Heart Association, Dallas, Texas
Wood D, De Backer G, Faergeman O et al (1998) Prevention of coronary heart disease in clinical practice: recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis 140:199–270
Sans S, Kesteloot H, Kromhout D (1997) The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J 18:1231–1248
http://epp.eurostat.cec.eu.int. Accessed 08/06/2007
Libby P (2001) Current concepts of the pathogenesis of the acute coronary syndromes. Circulation 104:365–372
Glagov S, Weisenberg E, Zarins CK et al (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316:1371–1375
Clarkson TB, Prichard RW, Morgan TM et al (1994) Remodeling of coronary arteries in human and nonhuman primates. JAMA 271:289–294
Varnava AM, Mills PG, Davies MJ (2002) Relationship between coronary artery remodeling and plaque vulnerability. Circulation 105:939–943
Little WC (1990) Angiographic assessment of the culprit coronary artery lesion before acute myocardial infarction. Am J Cardiol 66:44G–47G
Davies MJ, Richardson PD, Woolf N et al (1993) Risk of thrombosis in human atherosclerotic plaques: role of extracellular lipid, macrophage, and smooth muscle cell content. Br Heart J 69:377–381
Moreno PR, Falk E, Palacios IF et al (1994) Macrophage infiltration in acute coronary syndromes. Implications for plaque rupture. Circulation 90:775–778
Mann JM, Davies MJ (1996) Vulnerable plaque. Relation of characteristics to degree of stenosis in human coronary arteries. Circulation 94:928–931
Muller JE, Abela GS, Nesto RW et al (1994) Triggers, acute risk factors and vulnerable plaques: the lexicon of a new frontier. J Am Coll Cardiol 23:809–813
Burke AP, Farb A, Malcom GT et al (1997) Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med 336:1276–1282
Falk E, Shah PK, Fuster V (1995) Coronary plaque disruption. Circulation 92:657–671
Upston JM, Niu X, Brown AJ et al (2002) Disease stage-dependent accumulation of lipid and protein oxidation products in human atherosclerosis. Am J Pathol 160:701–710
Kolodgie FD, Burke AP, Farb A et al (2001) The thin-cap fibroatheroma: a type of vulnerable plaque: the major precursor lesion to acute coronary syndromes. Curr Opin Cardiol 16:285–292
Galis ZS, Sukhova GK, Lark MW et al (1994) Increased expression of matrix metalloproteinases and matrix degrading activity in vulnerable regions of human atherosclerotic plaques. J Clin Invest 94:2493–2503
Lee RT, Schoen FJ, Loree HM et al (1996) Circumferential stress and matrix metalloproteinase 1 in human coronary atherosclerosis. Implications for plaque rupture. Arterioscler Thromb Vasc Biol 16:1070–1073
Virmani R, Kolodgie FD, Burke AP et al (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20:1262–1275
Naghavi M, Libby P, Falk E et al (2003) From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 108:1664–1672
Naghavi M, Libby P, Falk E et al (2003) From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. Circulation 108:1772–1778
Galbraith JE, Murphy ML, de Soyza N (1978) Coronary angiogram interpretation. Interobserver variability. JAMA 240:2053–2056
Grondin CM, Dyrda I, Pasternac A et al (1974) Discrepancies between cineangiographic and postmortem findings in patients with coronary artery disease and recent myocardial revascularization. Circulation 49:703–708
Topol EJ, Nissen SE (1995) Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 92:2333–2342
Fishbein MC, Siegel RJ (1996) How big are coronary atherosclerotic plaques that rupture? Circulation 94:2662–2666
Fitzgerald PJ, St Goar FG, Connolly AJ et al (1992) Intravascular ultrasound imaging of coronary arteries. Is three layers the norm? Circulation 86:154–158
Nissen SE, Yock P (2001) Intravascular ultrasound: novel pathophysiological insights and current clinical applications. Circulation 103:604–616
Potkin BN, Bartorelli AL, Gessert JM et al (1990) Coronary artery imaging with intravascular high-frequency ultrasound. Circulation 81:1575–1585
Nissen SE, Gurley JC, Grines CL et al (1991) Intravascular ultrasound assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease. Circulation 84:1087–1099
Mintz GS, Nissen SE, Anderson WD et al (2001) American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37:1478–1492
Hausmann D, Johnson JA, Sudhir K et al (1996) Angiographically silent atherosclerosis detected by intravascular ultrasound in patients with familial hypercholesterolemia and familial combined hyperlipidemia: correlation with high density lipoproteins. J Am Coll Cardiol 27:1562–1570
Maheswaran B, Leung CY, Gutfinger DE et al (1995) Intravascular ultrasound appearance of normal and mildly diseased coronary arteries: correlation with histologic specimens. Am Heart J 130:976–986
Tobis JM, Mallery J, Mahon D et al (1991) Intravascular ultrasound imaging of human coronary arteries in vivo. Analysis of tissue characterizations with comparison to in vitro histological specimens. Circulation 83:913–926
Mintz GS, Douek P, Pichard AD et al (1992) Target lesion calcification in coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol 20:1149–1155
von Birgelen C, Klinkhart W, Mintz GS et al (2001) Plaque distribution and vascular remodeling of ruptured and nonruptured coronary plaques in the same vessel: an intravascular ultrasound study in vivo. J Am Coll Cardiol 37:1864–1870
Yamagishi M, Terashima M, Awano K et al (2000) Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome. J Am Coll Cardiol 35:106–111
Ge J, Chirillo F, Schwedtmann J et al (1999) Screening of ruptured plaques in patients with coronary artery disease by intravascular ultrasound. Heart 81:621–627
Hong MK, Mintz GS, Lee CW et al (2004) Comparison of coronary plaque rupture between stable angina and acute myocardial infarction: a three-vessel intravascular ultrasound study in 235 patients. Circulation 110:928–933
Hong MK, Mintz GS, Lee CW et al (2005) The site of plaque rupture in native coronary arteries: a three-vessel intravascular ultrasound analysis. J Am Coll Cardiol 46:261–265
Rioufol G, Finet G, Ginon I et al (2002) Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Circulation 106:804–808
Nair A, Kuban BD, Tuzcu EM et al (2002) Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 106:2200–2206
Kawasaki M, Takatsu H, Noda T et al (2002) In vivo quantitative tissue characterization of human coronary arterial plaques by use of integrated backscatter intravascular ultrasound and comparison with angioscopic findings. Circulation 105:2487–2492
McLeod AL, Watson RJ, Anderson T et al (2004) Classification of arterial plaque by spectral analysis in remodelled human atherosclerotic coronary arteries. Ultrasound Med Biol 30:155–159
Hausmann D, Erbel R, Alibelli-Chemarin MJ et al (1995) The safety of intracoronary ultrasound. A multicenter survey of 2207 examinations. Circulation 91:623–630
Batkoff BW, Linker DT (1996) Safety of intracoronary ultrasound: data from a Multicenter European Registry. Cathet Cardiovasc Diagn 38:238–241
de Korte CL, Pasterkamp G, van der Steen AF et al (2000) Characterization of plaque components with intravascular ultrasound elastography in human femoral and coronary arteries in vitro. Circulation 102:617–623
Schaar JA, Regar E, Mastik F et al (2004) Incidence of high-strain patterns in human coronary arteries: assessment with three-dimensional intravascular palpography and correlation with clinical presentation. Circulation 109:2716–2719
Lendon CL, Davies MJ, Born GV et al (1991) Atherosclerotic plaque caps are locally weakened when macrophages density is increased. Atherosclerosis 87:87–90
Madjid M, Naghavi M, Malik BA et al (2002) Thermal detection of vulnerable plaque. Am J Cardiol 90:36L–39L
Stefanadis C, Toutouzas K, Tsiamis E et al (2001) Increased local temperature in human coronary atherosclerotic plaques: an independent predictor of clinical outcome in patients undergoing a percutaneous coronary intervention. J Am Coll Cardiol 37:1277–1283
Mizuno K, Satomura K, Miyamoto A et al (1992) Angioscopic evaluation of coronary-artery thrombi in acute coronary syndromes. N Engl J Med 326:287–291
de Feyter PJ, Ozaki Y, Baptista J et al (1995) Ischemia-related lesion characteristics in patients with stable or unstable angina. A study with intracoronary angioscopy and ultrasound. Circulation 92:1408–1413
Takano M, Inami S, Ishibashi F et al (2005) Angioscopic follow-up study of coronary ruptured plaques in nonculprit lesions. J Am Coll Cardiol 45:652–658
Patel NA, Stamper DL, Brezinski ME (2005) Review of the ability of optical coherence tomography to characterize plaque, including a comparison with intravascular ultrasound. Cardiovasc Intervent Radiol 28:1–9
Yabushita H, Bouma BE, Houser SL et al (2002) Characterization of human atherosclerosis by optical coherence tomography. Circulation 106:1640–1645
Jang IK, Bouma BE, Kang DH et al (2002) Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound. J Am Coll Cardiol 39:604–609
Raman C (1928) A new type of secondary radiation. Nature 121:501–502
Brennan JF 3rd, Romer TJ, Lees RS et al (1997) Determination of human coronary artery composition by Raman spectroscopy. Circulation 96:99–105
Romer TJ, Brennan JF 3rd. Fitzmaurice M et al (1998) Histopathology of human coronary atherosclerosis by quantifying its chemical composition with Raman spectroscopy. Circulation 97:878–885
Buschman HP, Marple ET, Wach ML et al (2000) In vivo determination of the molecular composition of artery well by intravascular Raman spectroscopy. Anal Chem 72:3771–3775
Moreno PR, Lodder RA, Purushothaman KR et al (2002) Detection of lipid pool, thin fibrous cap, and inflammatory cells in human aortic atherosclerotic plaques by near-infrared spectroscopy. Circulation 105:923–927
Wang J, Geng YJ, Guo B et al (2002) Near-infrared spectroscopic characterization of human advanced atherosclerotic plaques. J Am Coll Cardiol 39:1305–1313
Yuan C, Murakami JW, Hayes CE et al (1995) Phased-array magnetic resonance imaging of the carotid artery bifurcation: preliminary results in healthy volunteers and a patient with atherosclerotic disease. J Magn Reson Imaging 5:561–565
Hatsukami TS, Ross R, Polissar NL et al (2000) Visualization of fibrous cap thickness and rupture in human atherosclerotic carotid plaque in vivo with high-resolution magnetic resonance imaging. Circulation 102:959–964
Simonetti OP, Finn JP, White RD et al (1996) “Black blood” T2-weighted inversion-recovery MR imaging of the heart. Radiology 199:49–57
Kooi ME, Cappendijk VC, Cleutjens KB et al (2003) Accumulation of ultrasmall superparamagnetic particles of iron oxide in human atherosclerotic plaques can be detected by in vivo magnetic resonance imaging. Circulation 107:2453–2458
Bornert P, Stuber M, Botnar RM et al (2002) Comparison of fat suppression strategies in 3D spiral coronary magnetic resonance angiography. J Magn Reson Imaging 15:462–466
Fayad ZA, Fuster V, Fallon JT et al (2000) Noninvasive in vivo human coronary artery lumen and wall imaging using black-blood magnetic resonance imaging. Circulation 102:506–510
Botnar RM, Stuber M, Kissinger KV et al (2000) Noninvasive coronary vessel wall and plaque imaging with magnetic resonance imaging. Circulation 102:2582–2587
Itskovich VV, Samber DD, Mani V et al (2004) Quantification of human atherosclerotic plaques using spatially enhanced cluster analysis of multicontrast-weighted magnetic resonance images. Magn Reson Med 52:515–523
Worthley SG, Helft G, Fuster V et al (2003) A novel nonobstructive intravascular MRI coil: in vivo imaging of experimental atherosclerosis. Arterioscler Thromb Vasc Biol 23:346–350
Farrar CT, Wedeen VJ, Ackerman JL (2005) Cylindrical meanderline radiofrequency coil for intravascular magnetic resonance studies of atherosclerotic plaque. Magn Reson Med 53:226–230
Ohtsuki K, Hayase M, Akashi K et al (2001) Detection of monocyte chemoattractant protein-1 receptor expression in experimental atherosclerotic lesions: an autoradiographic study. Circulation 104:203–208
Davies JR, Rudd JH, Weissberg PL (2004) Molecular and metabolic imaging of atherosclerosis. J Nucl Med 45:1898–1907
Rudd JH, Warburton EA, Fryer TD et al (2002) Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation 105:2708–2711
Mukai T, Nohara R, Ogawa M et al (2004) A catheter-based radiation detector for endovascular detection of atheromatous plaques. Eur J Nucl Med Mol Imaging 31:1299–1303
Bischoff J (1995) Approaches to studying cell adhesion molecules in angiogenesis. Trends Cell Biol 5:69–74
Brack SS, Dinkelborg LM, Neri D (2004) Molecular targeting of angiogenesis for imaging and therapy. Eur J Nucl Med Mol Imaging 31:1327–1341
Kolodgie FD, Gold HK, Burke AP et al (2003) Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 349:2316–2325
Matter CM, Schuler PK, Alessi P et al (2004) Molecular imaging of atherosclerotic plaques using a human antibody against the extra-domain B of fibronectin. Circ Res 95:1225–1233
Tanenbaum SR, Kondos GT, Veselik KE et al (1989) Detection of calcific deposits in coronary arteries by ultrafast computed tomography and correlation with angiography. Am J Cardiol 63:870–872
Rumberger JA, Simons DB, Fitzpatrick LA et al (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92:2157–2162
Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832
Shaw LJ, Raggi P, Schisterman E et al (2003) Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology 228:826–833
Greenland P, Abrams J, Aurigemma GP et al (2000) Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III. Circulation 101:E16–E22
Greenland P, LaBree L, Azen SP et al (2004) Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 291:210–215
Taylor AJ, Feuerstein I, Wong H et al (2001) Do conventional risk factors predict subclinical coronary artery disease? Results from the Prospective Army Coronary Calcium Project. Am Heart J 141:463–468
O’Rourke RA, Brundage BH, Froelicher VF et al (2000) American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation 102:126–140
Knez A, Becker C, Becker A et al (2002) Determination of coronary calcium with multi-slice spiral computed tomography: a comparative study with electron-beam CT. Int J Cardiovasc Imaging 18:295–303
Nikolaou K, Flohr T, Knez A et al (2004) Advances in cardiac CT imaging: 64-slice scanner. Int J Cardiovasc Imaging 20:535–540
Leschka S, Alkadhi H, Plass A et al (2005) Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur Heart J 26:1482–1487
Leber AW, Knez A, von Ziegler F et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46:147–154
Cademartiri F, Runza G, Marano R et al (2005) Diagnostic accuracy of 16-row multislice CT angiography in the evaluation of coronary segments. Radiol Med 109:91–97
Cademartiri F, van der Lugt A, Luccichenti G et al (2002) Parameters affecting bolus geometry in CTA: a review. J Comput Assist Tomogr 26:598–607
Cademartiri F, Nieman K, van der Lugt A et al (2004) Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology 233:817–823
Ropers D, Baum U, Pohle K et al (2003) Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 107:664–666
Mollet NR, Cademartiri F, Nieman K et al (2004) Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris. J Am Coll Cardiol 43:2265–2270
Kuettner A, Trabold T, Schroeder S et a al (2004) Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results. J Am Coll Cardiol 44:1230–1237
Nikolaou K, Sagmeister S, Knez A et al (2003) Multidetector-row computed tomography of the coronary arteries: predictive value and quantitative assessment of non-calcified vesselwall changes. Eur Radiol 13:2505–2512
Becker CR, Knez A, Ohnesorge B et al (2000) Imaging of noncalcified coronary plaques using helical CT with retrospective ECG gating. AJR Am J Roentgenol 175:423–424
Estes JM, Quist WC, Lo Gerfo FW et al (1998) Noninvasive characterization of plaque morphology using helical computed tomography. J Cardiovasc Surg 39:527–534
Kopp AF, Schroeder S, Baumbach A et al (2001) Non-invasive characterisation of coronary lesion morphology and composition by multislice CT: first results in comparison with intracoronary ultrasound. Eur Radiol 11:1607–1611
Schroeder S, Kopp AF, Baumbach A et al (2001) Noninvasive detection and evaluation of atherosclerotic coronary plaques with multislice computed tomography. J Am Coll Cardiol 37:1430–1435
Leber AW, Knez A, Becler A et al (2004) Accuracy of multidetector spiral computed tomography in identifying and differentiating the composition of coronary atherosclerotic plaques: a comparative study with intracoronary ultrasound. J Am Coll Cardiol 43:1241–1247
Achenbach S, Moselewski F, Ropers D et al (2004) Detection of calcified and noncalcified coronary atherosclerotic plaque by contrast-enhanced, submillimeter multidetector spiral computed tomography: a segment-based comparison with intravascular ultrasound. Circulation 109:14–17
Leber AW, Knez A, White CW et al (2003) Composition of coronary atherosclerotic plaques in patients with acute myocardial infarction and stable angina pectoris determined by contrast-enhanced multislice computed tomography. Am J Cardiol 91:714–718
Inoue F, Sato Y, Matsumoto N et al (2004) Evaluation of plaque texture by means of multislice computed tomography in patients with acute coronary syndrome and stable angina. Circ J 68:840–844
Schmermund A, Baumgart D, Adamzik M et al (1998) Comparison of electron-beam computed tomography and intracoronary ultrasound in detecting calcified and noncalcified plaques in patients with acute coronary syndromes and no or minimal to moderate angiographic coronary artery disease. Am J Cardiol 81:141–146
Caussin C, Ohanessian A, Lancelin B et al (2003) Coronary plaque burden detected by multislice computed tomography after acute myocardial infarction with near-normal coronary arteries by angiography. Am J Cardiol 92:849–852
Nikolaou K, Becker CR, Muders M et al (2004) Multidetector-row computed tomography and magnetic resonance imaging of atherosclerotic lesions in human ex vivo coronary arteries. Atherosclerosis 174:243–252
Becker CR, Nikolaou K, Muders M et al (2003) Ex vivo coronary atherosclerotic plaque characterization with multi-detector-row CT. Eur Radiol 13:2094–2098
Schroeder S, Kuettner A, Wojak T et al (2004) Non-invasive evaluation of atherosclerosis with contrast enhanced 16 slice spiral computed tomography: results of ex vivo investigations. Heart 90:1471–1475
Schroeder S, Kuettner A, Leitritz M et al (2004) Reliability of differentiating human coronary plaque morphology using contrast-enhanced multislice spiral computed tomography: a comparison with histology. J Comput Assist Tomogr 28:449–454
Schroeder S, Flohr T, Kopp AF et al (2001) Accuracy of density measurements within plaques located in artificial coronary arteries by X-ray multislice CT: results of a phantom study. J Comput Assist Tomogr 25:900–906
Cademartiri F, Mollet NR, Runza G et al (2005) Influence of intracoronary attenuation on coronary plaque measurements using multislice computed tomography: observations in an ex vivo model of coronary computed tomography angiography. Eur Radiol 15:1426–1431
Libby P, Sukhova G, Lee RT et al (1997) Molecular biology of atherosclerosis. Int J Cardiol 62[Suppl 2]:S23–S29
Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340:115–126
Romer TJ, Brennan JF 3rd. Puppels GJ et al (2000) Intravascular ultrasound combined with Raman spectroscopy to localize and quantify cholesterol and calcium salts in atherosclerotic coronary arteries. Arterioscler Thromb Vasc Biol 20:478–483
Nieman K, Oudkerk M, Rensing BJ et al (2001) Coronary angiography with multi-slice computed tomography. Lancet 357:599–603
Burke AP, Virmani R, Galis Z et al (2003) 34th Bethesda Conference: Task force #2—What is the pathologic basis for new atherosclerosis imaging techniques? J Am Coll Cardiol 41:1874–1886
Moselewski F, Ropers D, Pohle K et al (2004) Comparison of measurement of cross-sectional coronary atherosclerotic plaque and vessel areas by 16-slice multidetector computed tomography versus intravascular ultrasound. Am J Cardiol 94:1294–1297
Schoenhagen P, Tuzcu EM, Stillman AE et al (2003) Non-invasive assessment of plaque morphology and remodeling in mildly stenotic coronary segments: comparison of 16-slice computed tomography and intravascular ultrasound. Coron Artery Dis 14:459–462
Schoenhagen P, Ziada KM, Kapadia SR et al (2000) Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 101:598–603
Achenbach S, Ropers D, Hoffmann U et al (2004) Assessment of coronary remodeling in stenotic and nonstenotic coronary atherosclerotic lesions by multidetector spiral computed tomography. J Am Coll Cardiol 43:842–847
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Cademartiri, F., La Grutta, L., Palumbo, A. et al. Imaging techniques for the vulnerable coronary plaque. Radiol med 112, 637–659 (2007). https://doi.org/10.1007/s11547-007-0170-4
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DOI: https://doi.org/10.1007/s11547-007-0170-4