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Current Imaging Approaches and Challenges in the Assessment of Coronary Artery Disease

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Vessel Based Imaging Techniques

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Abstract

For a long time, the diagnosis of coronary diseases was exclusively focused on vessel lumen narrowing. Advances in the knowledge of coronary artery diseases have progressively raised awareness of changes in the vessel wall. The study of the vessel wall allows the identification of changes in early stages of diseases as well as signs of plaque vulnerability or increased risk for complications.

The techniques used to study the wall of the coronary arteries are divided into invasive and noninvasive. Intravascular ultrasound is currently widely used. It provides very good quality images of all coronary wall layers and allows the identification of plaque components, extension, and volume but mainly plaque vulnerability characteristics. Optical coherence tomography is considered by many to be the gold standard for analysis of the coronary artery wall. Its great advantage in relation to intravascular ultrasound is the excellent spatial resolution that allows the detailed analysis of the intima layer, determining its thickness and integrity and contributing significantly to defining patients at greater risk. Both of these techniques are invasive.

Magnetic resonance imaging allows safe and noninvasive coronary wall study. It assesses the thickness of the coronary wall, positive remodeling, and plaque burden in addition to other signs of plaque vulnerability such as high-intensity plaques and contrast uptake in delay enhancement techniques. Coronary artery tomography allows analysis of high-risk features such as positive remodeling, plaque component, plaque burden, and signs of plaque vulnerability. The noninvasive nature of the CT scan has increased its use in risk stratification of patients with suspected subclinical atherosclerotic disease.

In this chapter we will discuss the main characteristics of these methods of evaluation of coronary artery walls, pointing out their clinical utilities, advantages, and limitations.

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Authors and Affiliations

  1. Federal University of Santa Maria, Santa Maria, Brazil

    Mateus Diniz Marques

  2. Johns Hopkins Hospital, Baltimore, MD, USA

    João Augusto Costa Lima

  3. Radiology and Epidemiology at the Johns Hopkins School of Medicine, Baltimore, MD, USA

    João Augusto Costa Lima

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  1. Mateus Diniz Marques
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  1. University of Washington, Seattle, WA, USA

    Chun Yuan

  2. University of Washington, Seattle, WA, USA

    Thomas S. Hatsukami

  3. University of Washington, Seattle, WA, USA

    Mahmud Mossa-Basha

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Marques, M.D., Lima, J.A.C. (2020). Current Imaging Approaches and Challenges in the Assessment of Coronary Artery Disease. In: Yuan, C., Hatsukami, T., Mossa-Basha, M. (eds) Vessel Based Imaging Techniques . Springer, Cham. https://doi.org/10.1007/978-3-030-25249-6_12

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