Cardiovascular Imaging Techniques for Detection of Vulnerable Plaques

DOI: 10.2478/jim-2021-0008


Various cardiovascular imaging techniques were developed for detection of vulnerable atherosclerotic plaques, hoping to be able to predict a cardiovascular event. Plaque vulnerability results from compound pathophysiological mechanisms that lead to structural and morphological changes in lesions. The aim of this review is to present the most recent techniques for assessment of vulnerable coronary plaques, such as cardiac computed tomography angiography (CCTA), optical coherence tomography, or virtual histology intravascular ultrasound, based on literature data from the last 3 years. CCTA permits direct visualization of the intravascular lumen, together with the arterial wall characterization. The recent studies maintain that lowattenuation plaques, spotty calcifications, positive vessel remodeling, and napkin-ring sign are considered main markers of plaque vulnerability and instability. Emerging analytical techniques such as machine learning or radiomics will probably demonstrate useful as an auxiliary diagnostic tool for vulnerable plaque detection. The data from the two imaging techniques together provide useful information, especially in patients undergoing a PCI procedure for ACS. Invasive and noninvasive imaging techniques are able to deliver a large amount of scientific data to provide vulnerable coronary atheromatous plaques. Recent studies demonstrated that information defined by the two techniques is complementary and using the both methods is essential for adequate diagnosis, therapeutic strategy and prognostic assessment. Emerging technologies and analytical techniques such as machine learning, and radiomics will probably provide a useful platform for future developments in coronary imaging.