The evolution of atherosclerotic plaque is represented by accumulation of lipoprotein in the intima. Oxidative stress induce local leukocyte migration into the intima with development of foam cells and growing of atherosclerotic plaque. In this manner the fatty streak can evolve into a fibrofatty lesion. In the later stage calcification can occur and fibrosis continues, yielding a fibrous capsule surrounding a lipid-rich core. Two-thirds of myocardial infarcts involve a fracture of the plaque’s fibrous cup. The so-called “ vulnerable” plaque shows a relative lack of smooth muscle cells due to inflammatory mediators, the prominent accumulation of macrophages and large lipid pool. Thus, the imaging modality of choice should be useful to distinguish lipid core and inflammatory reaction. Intravascular ultrasound (IVUS) is an invasive modality considered useful to distinguish fibrous and calcified plaques with respect to “soft” or “mixed” plaque with higher spatial resolution than any other imaging modality. MDCT has the ability to provide high definition and thin section images. Low attenuation values are related to “soft” plaque. The main advantage over IVUS is related to its ability to visualize the entire coronary tree and its burden plaque. Radionuclide imaging of vulnerable plaques is focused on targeting the lipidic core, the macrophage infiltration or the proliferating smooth muscle cells by means of SPECT and PET-CT. A new horizon in the imaging of atherosclerotic plaque is the use of MRI contrast enhancing agents to investigate molecular and cellular marker also using a self contained intravascular magnetic resonance imaging probe. Learning Objectives: 1. To correlate the pathophysiology of plaque formation with imaging. 2. To present the different methods of imaging the plaque. 3. To familiarize with the advantages and limitations of each method.

The atherosclerotic plaque A.Plaque imaging: development of modern imaging methods

DI CESARE, Ernesto
2006

Abstract

The evolution of atherosclerotic plaque is represented by accumulation of lipoprotein in the intima. Oxidative stress induce local leukocyte migration into the intima with development of foam cells and growing of atherosclerotic plaque. In this manner the fatty streak can evolve into a fibrofatty lesion. In the later stage calcification can occur and fibrosis continues, yielding a fibrous capsule surrounding a lipid-rich core. Two-thirds of myocardial infarcts involve a fracture of the plaque’s fibrous cup. The so-called “ vulnerable” plaque shows a relative lack of smooth muscle cells due to inflammatory mediators, the prominent accumulation of macrophages and large lipid pool. Thus, the imaging modality of choice should be useful to distinguish lipid core and inflammatory reaction. Intravascular ultrasound (IVUS) is an invasive modality considered useful to distinguish fibrous and calcified plaques with respect to “soft” or “mixed” plaque with higher spatial resolution than any other imaging modality. MDCT has the ability to provide high definition and thin section images. Low attenuation values are related to “soft” plaque. The main advantage over IVUS is related to its ability to visualize the entire coronary tree and its burden plaque. Radionuclide imaging of vulnerable plaques is focused on targeting the lipidic core, the macrophage infiltration or the proliferating smooth muscle cells by means of SPECT and PET-CT. A new horizon in the imaging of atherosclerotic plaque is the use of MRI contrast enhancing agents to investigate molecular and cellular marker also using a self contained intravascular magnetic resonance imaging probe. Learning Objectives: 1. To correlate the pathophysiology of plaque formation with imaging. 2. To present the different methods of imaging the plaque. 3. To familiarize with the advantages and limitations of each method.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11697/22317
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