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<title></title>
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<para> J. Appl. Biomed.</para>
<para>6: 1–14, 2008</para>
<para>ISSN 1214-0287</para>
<para></para>
<para></para>
<para>REVIEW</para>
<para></para>
<para>Plaque imaging: clinical implications and use of invasive methods</para>
<para></para>
<para>Stanislav Tůma1, David Tesař2, Josef Veselka3, Jiří Neuwirth2</para>
<para></para>
<para>1Institute of Radiology and Toxicology, Faculty of Health and Social Studies, University of South Bohemia in
České Budějovice, Czech Republic</para>
<para>2Clinic of Imaging Methods, 2nd Medical Faculty, Charles University, Prague, Czech Republic </para>
<para>3Center of Cardiology and Cardiac Surgery, University Hospital Motol, Prague, Czech Republic </para>
<para></para>
<para></para>
<para>Received 5th October 2007.</para>
<para>Revised 30th December 2007.</para>
<para>Published online 10th January 2008.</para>
<para></para>
<para></para>
<para></para>
<para>Summary</para>
<para>The composition of artherosclerotic plaque can be distingushed from the normal physical properties of
tissues by the inflammatory mediators and the cells‘ remodelling arterial walls, and can therefore be
demonstrated by imaging methods. Imaging of the vulnerable atherosclerotic plaque is now accepted as
the main target in the diagnostics of imminent acute complications in atherosclerosis. Recent results of
clinical trials (Ross´s, CAPTIM, Prague) suggest facilitated intervention – primary angioplasty together
with pre-hospital fibrinolysis during transportation – as the urgent therapeutical method of choice. This
life-saving emergency treatment is considered to be invasive because of the angiography and
intravascular ultrasonography. </para>
<para> Angiography ranges from digital subtraction angiography to three-dimensional imaging, together for
example with the rotational acquisition of angiographic pictures. X-ray densitometry of the
atherosclerotic plaque tissues is also a promising method for differentiation. In contrast, intravascular
ultrasonography, by the direct use of varying frequencies, allows the differentiation of tissues, and the
demonstration of their relationship by virtual histology. The plaques liable to rupture (unstable vulnerable
plaques) contain a large lipid core covered by a thin fibroplastic cap layer with a number of macrophages
and mastocytes, and it seems that they, the plaques, can be identified by a so called new “gold-standard“
modality. The usefulness of invasive methods is not only in distinguishing pathological processes or the
location and size of the atherosclerotic plaque and its calcified parts, but in attracting attention to the
extent of its vulnerability. The response to therapy of the arterial wall can also be demonstrated.</para>
<para></para>
<para>Keywords: atherosclerotic plaque; FDG-PET/CT; intravascular ultrasound; virtual histology; dual-source
mutidetector-row CT; three-dimensional rotational angiography</para>
<para></para>
<para></para>
<para></para>
<para></para>
<para>*Stanislav Tůma, Institute of Radiology and Toxicology, Faculty of Health and Social Studies, MEDIPOINT,
Matice Školské 17, 370 01 České Budějovice, Czech Republic</para>
<para>: sttuma@volny.cz</para>
<para>( +420 777 620 408</para>
<para></para>
<para></para>
<para></para>
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