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Abstract
Atherosclerosis imaging goes beyond the simple identification of luminal stenosis. Besides stenosis measurement, there are two main motivations for atherosclerosis imaging: one is to identify the so-called vulnerable plaque, defined as atherosclerotic plaque that poses increased risk of rupture and clinical events, such as heart attack or stroke; the other is to identify ‘positively remodelled’ plaques—plaques that grow outward from the lumen but cause minimal or no stenosis. Cardiovascular magnetic resonance (CMR) has histologically validated capabilities to characterize carotid plaque features in vivo, including a lipid-rich necrotic core, fibrous cap, intraplaque haemorrhage (IPH), calcification, and inflammation. A multicontrast two-dimensional imaging approach has been used in many prospective studies relating baseline CMR characteristics of carotid atherosclerosis with plaque progression and clinical events. These studies have demonstrated the importance of detecting IPH, lipid-rich necrotic cores, and fibrous caps. Building on these findings, a number of three-dimensional CMR techniques have been recently developed that allow higher spatial resolution plaque imaging and easier application clinically with short scan times. Three-dimensional plaque imaging offers flexible imaging plane and view angle analysis, large coverage, multivascular beds capability, and is a fast and cost-effective screening for clinical use. Atherosclerosis imaging has also been applied to detect plaques in other vascular beds such as the coronary artery, intracranial artery, and peripheral artery, although each bed comes with unique imaging needs. Large-scale studies are needed to determine the impact of atherosclerotic plaque CMR on patient outcomes.
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