Cellular and molecular imaging of coronary atherosclerosis: clinical applications

Reversing initial gains realized in the 1990s-2010s, coronary artery disease rates are now increasing and represent the dominant cause of death in many parts of the world. In recent years, substantive advances in non-invasive and invasive structural-based imaging techniques that delineate atheroma burden and anatomical composition have increased understanding of the pathogenesis of atherosclerosis. Driven by advances in imaging agent and hardware technology, the burgeoning field of molecular imaging has enabled clinical visualization of molecules and cells that underpin atherosclerosis pathobiology. Integrating the molecular and anatomical measures of atherosclerosis has promoted a deeper understanding of disease progression, patient-specific risk, and the effects of atherosclerosis pharmacotherapeutics and devices. With the great recognition of the role of inflammation as a residual risk marker of adverse outcomes for coronary artery disease patients, cellular and molecular imaging of inflammation and other disease activities is positioned to usher in a new era of risk assessment and personalized medical and interventional therapeutics for atherosclerosis patients. Moreover, molecular imaging offers the potential for assessing the actions of interventions on atherogenic processes, validating effects in vivo, and possibly informing optimal dose selection and treatment duration. This review will present the state-of-the-art in coronary artery disease cellular and molecular imaging and provide a roadmap for near-term translational and clinical applications.