Molecular imaging of vulnerable plaque by cardiac magnetic resonance imaging

Coronary atherosclerosis is known to be the major cause for morbidity and mortality in the industrial world. In Europe, every year similar to 600,000 persons die from coronary artery disease, a majority of them without any prior symptoms. Plaque rupture, mostly of noncalcified vulnerable plaques, is supposed to play a major role in this setting, and noninvasive techniques are mandatory to stratify the individual risk for experiencing an acute coronary event. During the last decade, magnetic resonance imaging has gained importance as a noninvasive imaging technique in cardiology. Continuous technical improvements enabled a rapidly expanding field of application, and recently noninvasive imaging of plaques has been introduced. In addition to morphological characterization, functional imaging of plaques has gained interest for a more specific risk assessment. This article summarizes pathophysiological aspects of the concept of vulnerable plaque, technical requirements for noninvasive plaque imaging, and characterization with magnetic resonance imaging.