Diagnosis of Atherosclerosis by Imaging

Coronary angiogram shows severe stenosis in the mid left anterior descending (yellow arrow) and proximal circumflex coronary (red arrow) arteries.

Intravascular ultrasound (IVUS) obtained from the left anterior descending coronary artery in a patient with minimal obstructive disease by angiography. The yellow dashed line indicates the external elastic membrane of the vessel, and the blue dashed line indicates the lumen. The red arrow indicates the position of the catheter in the vessel lumen, and the yellow arrow shows an area of eccentric remodeling caused by noncalcified plaque.

Ultrasound obtained from (A) normal and (B) atherosclerotic carotid arteries. The layer indicated by the 2 parallel lines in A of the normal carotid artery is the intima-media thickness. The thick yellow arrow in B shows a large noncalcified plaque.

Magnetic resonance angiogram in an asymptomatic patient with atherosclerosis. (A) Contrast-enhanced angiogram shows bilateral common carotid artery stenosis (arrows). (B) Black blood cross-sectional image reveals atherosclerotic plaques in the left external and internal carotid arteries (arrows).

Magnetic resonance cross-sectional images at the same level of the aorta in a patient treated with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). The similar pattern of the coronary vessels at each time indicates that the images were well matched. The aorta is indicated by yellow arrows in the top row. In the detailed view of the descending aorta (bottom row), arrows indicate maximal atherosclerotic plaque size. Note that after 6 months of treatment, the plaque volume is similar, revealing a halt in plaque progression. At 12 months, plaque volume shrinkage is seen. (Reprinted with permission from Circulation.⁴²)

(A) Multidetector computed tomography (MDCT) axial image obtained from an asymptomatic patient shows mild narrowing of the proximal left anterior descending coronary artery caused by a noncalcified plaque (arrow). (B) MDCT oblique axial image obtained from a patient with atypical chest pain reveals eccentric calcified plaques (arrow) with mild stenosis of the proximal left anterior descending coronary artery.