Dr. Laurent Riou
The basic science session “Imaging meets biology” provided an update on the use of the main imaging modalities that have clinical potential for the detection of vulnerable atherosclerotic plaques.
Professor Moritz Wildgruber (Munich, DE) reviewed the principles, advantages and drawbacks of molecular imaging modalities with special emphasis on the potential of invasive photoacoustic imaging for the detection of vulnerable lesions.
Professor Emmanouil Vavunarakis (Anoixi, GR) gave an excellent overview of the current knowledge regarding vasa vasorum in the setting of atherogenesis and underlined the deleterious consequences of vasa vasorum angiogenesis on plaque stability due to increased neovessel density, neovessel immaturity, and intraplaque hemorrage. He described the mechanisms and potential of contrast-enhanced ultrasound imaging for the assessment of atherosclerotic plaque neovascularisation. He stressed that several studies aimed at evaluating CEUS for vasa vasorum imaging of carotid atherosclerotic lesions have not objectively quantified the amount of lesional vasa vasorum, thereby limiting the conclusions that could be drawn.Nonlinear (harmonic response) imaging potential was also mentioned by Professor Vavuranakis through the presentation of clinical data obtained from stable and unstable carotid plaques and indicating the need for caution when interpreting CEUS images for the determination of plaque vulnerability. Finally, he reviewed the potential of nonlinear and differential IVUS imaging of coronary lesions and pointed out that IVUS detection of coronary lesions was less technically advanced than the CEUS examination of carotid arteries. He noted that molecular CEUS imaging should play a great role in the future.
Professor Olivier Gaemperli (Zurich, CH) discussed the role of inflammation in the development of vulnerable plaques and the potential molecular targets for the molecular imaging of plaque inflammation with special emphasis on SPECT/CT and TEP/CT. He reviewed the existing knowledge related to the use of FDG for PET imaging of carotid and coronary lesions and pointed the limitations of the tracer. The results recently obtained in patients with the macrophage tracer 11C-PK11195, as well as with the active calcification tracer 18F-NaF were then reviewed and the potential of molecular CT and spectral CT imaging was described.
The session ended with the talk of Professor Jean-Etienne Fabre (Strasbourg, FR) describing the use of MRI for the detection of activated platelets in vulnerable lesions. After reminding the audience of the basic physical principles underlying the use of MRI and the rational for targeting activated platelets for the imaging of vulnerable lesions, Prof. Fabre presented the data from preclinical studies evaluating the activated platelet – specific P975 and LIBS-MPIO agents using classical model of thrombosis. Very interestingly, he then presented experimental data acquired on an experimental model of mild, non occlusive thrombosis, and demonstrated that non invasive MRI using the LIBS-MPIO agent was able to detect sub-occlusive thrombosis providing that thrombus size was >2% of vessel lumen. Importantly, the feasibility of human vessel imaging was demonstrated by ex vivo MRI imaging of micro thrombi lying at the surface of an unstable, human carotid plaque.
Imaging meets biology: new strategies to identify high risk patients
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