ABSTRACT
Future improvements in non-invasive imaging modalities Future potentials – MR plaque imaging Thinner slices, such as those obtained with three-dimensional MR acquisition techniques, could further improve artery wall imaging.40 Details on the impact of spatial resolution on plaque characterization in the coronary arteries using MRI have recently been reported.79 It was shown that low spatial resolution is clearly associated with an overestimation of the wall area and underestimation of the lumen area. Additional MR techniques, such as water diffusion weighting,80
magnetization transfer weighting,17 steady-state free precession sequences,81
contrast enhancement,82 and molecular imaging83,84 may provide complementary structural information and allow more detailed plaque characterization. New and improved blood suppression methods40 are necessary for accurate plaque imaging, especially in the carotid artery bifurcation region. Contrast-enhanced MRA with the use of gadolinium-based contrast agents may provide additional information for plaque characterization by identifying neovascularization in the atherosclerotic plaque and potentially improve the differentiation between necrotic core and fibrous tissue.82 Furthermore, other non-specific and specific contrast agents may facilitate accurate plaque constituent characterization and the identification of specific molecular and biological activity.83,84 An example of promising specific contrast agents are fibrin-specific contrast agents, allowing for reliable detection of thrombotic material and for longitudinal study of thrombus progression or regression (Figure 6.8).85
