Imaging of the vulnerable plaque: new modalities.
Bhatia V, Bhatia R, Dhindsa S, Dhindsa M.; Department of Internal Medicine, State University of New
York at Buffalo, Buffalo, NY, USA.

Atherosclerosis is currently considered to be an inflammatory and thus a systemic disease affecting
multiple arterial beds. Recent advances in intravascular imaging have shown multiple sites of
atherosclerotic changes in coronary arterial wall. Traditionally, angiography has been used to detect and
characterize atherosclerotic plaque in coronary arteries, but recently it has been found that plaques that
are not significantly stenotic on angiography cause acute myocardial infarction. As a result, newer
imaging and diagnostic modalities are required to predict which of the atherosclerotic plaque are prone to
rupture and hence distinguish "stable" and "vulnerable" plaques. Intravascular ultrasound can identify
multiple plaques that are not seen on coronary angiography. Thermography has shown much promise
and is based on the concept that the inflammatory plaques are associated with increased
temperature and can also identify "vulnerable patients." Of all these newer modalities, magnetic
resonance imaging has shown the most promise in identification and characterization of vulnerable
plaques. In this article, we review the newer coronary artery imaging modalities and discuss the
limitations of traditional coronary angiography.