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Intravascular Molecular Imaging to Detect High-Risk Vulnerable Plaques: Current Knowledge and Future Perspectives
摘要： Purpose of Review To describe vulnerable plaque pathobiology and summarize potential targets for molecular imaging with a focus on intravascular near-infrared fluorescence (NIRF) and its translatable applications. Recent Findings Structural imaging alone is unable to precisely identify high-risk plaques in patients with coronary artery disease (CAD). Intravascular near-infrared fluorescence (NIRF) imaging is an emerging translational approach that can image specific in vivo molecular processes and cells that characterize vulnerable plaques. High-priority NIRF targets imaged by intravascular NIRF imaging thus far include macrophages, cathepsin protease activity, oxidized low-density lipoprotein (oxLDL), and abnormal endothelial permeability. The newest generation of NIRF catheters is multimodal in nature and combines NIRF with either IVUS or OCT, providing simultaneous co-registered morphological and pathobiological assessment of atherosclerotic plaques. While most intravascular NIRF studies have been performed in a preclinical environment, a first-in-human NIR autofluorescence-OCT trial has recently been performed. These developments suggest that clinical intravascular NIRF molecular imaging will be available within the next 3 years. Summary Molecular imaging is a powerful approach to enhance our understanding of atherosclerosis pathophysiology. Intravascular NIRF/OCT and NIRF/IVUS molecular imaging is nearing its use in atherosclerosis patients and will initially leverage indocyanine green (ICG) as an FDA-approved NIRF agent that reports on abnormal plaque permeability. Clinical trials are needed to assess the value of intravascular NIRF imaging using ICG as well as other novel NIRF imaging agents to better understand vulnerable plaque pathobiology, event prediction, and to enable personalized pharmacotherapy of high-risk plaques and patients.
关键词： Molecular imaging,Vulnerable plaque,Near-infrared spectroscopy,OCT,Atherosclerosis,Near-infrared fluorescence,IVUS
更新于2025-09-19 17:13:59
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Molecular imaging of the atherosclerotic plaque using positron emission tomography
摘要： Accurately assessing an individual’s risk of myocardial infarction or stroke using currently available risk stratification tools remains a challenge, even in patients with symptomatic disease. Inflammation, micro-calcification and intra-plaque angiogenesis occur during the development and ultimate rupture of vulnerable plaques. Molecular imaging techniques such as combined positron emission tomography and computed tomography (PET/CT) offer the opportunity to target these key cellular processes within atheroma and identify high-risk lesions. In this review we will set out the studies that have demonstrated the feasibility of PET/CT imaging in assessing atherosclerotic plaque inflammation, micro-calcification and angiogenesis. We will also discuss the potential of PET/CT molecular imaging as both a screening tool for novel therapeutic interventions and as a means of improving cardiovascular risk stratification.
关键词： inflammation,angiogenesis,vulnerable plaque,positron emission tomography,micro-calcification
更新于2025-09-10 09:29:36
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The role of near-infrared spectroscopy in the detection of vulnerable atherosclerotic plaques
摘要： Coronary artery disease is the leading cause of mortality worldwide. Most acute coronary syndromes are caused by a rupture of a vulnerable atherosclerotic plaque which can be characterized by a lipid-rich necrotic core with an overlying thin fibrous cap. Many vulnerable plaques can cause angiographically mild stenoses due to positive remodelling, which is why the extent of coronary artery disease may be seriously underestimated. In recent years, we have witnessed a paradigm shift in interventional cardiology. We no longer focus solely on the degree of stenosis; rather, we seek to determine the true extent of atherosclerotic disease. We seek to identify high-risk plaques for improvement in risk stratification of patients and prevention. Several imaging methods have been developed for this purpose. Intracoronary near-infrared spectroscopy is one of the most promising. Here, we discuss the possible applications of this diagnostic method and provide a comprehensive overview of the current knowledge.
关键词： vulnerable plaque,near-infrared spectroscopy,lipid-core plaque
更新于2025-09-04 15:30:14
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F-18 Fluoride Positron Emission Tomography-Computed Tomography for Detecting Atherosclerotic Plaques
摘要： A large number of major cardiovascular events occur in patients due to minimal or some lumen narrowing of the coronary artery. Recent biological studies have shown that the biological composition or vulnerability of the plaque is more critical for plaque rupture compared to the degree of stenosis. To overcome the limitations of anatomical images, molecular imaging techniques have been suggested as promising imaging tools in various fields. F-18 fluorodeoxyglucose (FDG), which is widely used in the field of oncology, is an example of molecular probes used in atherosclerotic plaque evaluation. FDG is a marker of plaque macrophage glucose utilization and inflammation, which is a prominent characteristic of vulnerable plaque. Recently, F-18 fluoride has been used to visualize vulnerable plaque in clinical studies. F-18 fluoride accumulates in regions of active microcalcification, which is normally observed during the early stages of plaque formation. More studies are warranted on the accumulation of F-18 fluoride and plaque formation/vulnerability; however, due to high specific accumulation, low background activity, and easy accessibility, F-18 fluoride is emerging as a promising non-invasive imaging probe to detect vulnerable plaque.
关键词： PET,Atherosclerosis,Vulnerable plaque,Fluoride
更新于2025-09-04 15:30:14