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The Vulnerable, or High-Risk, Atherosclerotic Plaque: Noninvasive MR Imaging for Characterization and Assessment¹

¹ From the Departments of Radiology (T.S., N.T., B.C., H.U., W.S.K., J.C., M.S.F., C.Y.) and Surgery (T.S.H.), University of Washington, Seattle, Wash; and Surgical Service, VA Puget Sound Health Care System, Seattle, Wash (T.S.H.). Received October 31, 2005; revision requested December 14; revision received January 17, 2005; accepted March 2; final version accepted July 17; final review and update by T.S. January 9, 2007. Address correspondence to T.S., Department of Clinical Radiology, Grosshadern Campus, University of Munich, Marchioni-nistr 15, 81377 Munich, Germany (e-mail: Tobias_Saam{at}med.uni-muenchen.de).

"Vulnerable" plaques are atherosclerotic plaques that have a high likelihood to cause thrombotic complications, such as myocardial infarction or stroke. Plaques that tend to progress rapidly are also considered to be vulnerable. Besides luminal stenosis, plaque composition and morphology are key determinants of the likelihood that a plaque will cause cardiovascular events. Noninvasive magnetic resonance (MR) imaging has great potential to enable characterization of atherosclerotic plaque composition and morphology and thus to help assess plaque vulnerability. A classification for clinical, as well as pathologic, evaluation of vulnerable plaques was recently put forward in which five major and five minor criteria to define vulnerable plaques were proposed. The purpose of this review is to summarize the status of MR imaging with regard to depiction of the criteria that define vulnerable plaques by using existing MR techniques. The use of MR imaging in animal models and in human disease in various vascular beds, particularly the carotid arteries, is presented.

© RSNA, 2007

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