Département de cardiologie, hôpital Lariboisière, Assistance Publique–Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris
Despite advances in our understanding of the pathogenesis of atherosclerosis and new therapeutic modalities, atherosclerosis and its thrombotic complications remain the leading causes of morbimortality in Western societies. The lack of an adequate imaging modality for early atherosclerotic plaque detection limits the prevention and treatment of the disease. Therefore, identification of high-risk atherosclerotic lesions prone to rupture and thrombosis may greatly decrease the morbidity and mortality associated with atherosclerosis. High-resolution magnetic resonance imaging (MRI) has recently emerged as one of the most promising techniques for the non-invasive study of atherothrombotic disease, as it can characterize plaque composition and monitor its progression. The development of MRI contrast agents that specifically target components of the atherosclerotic plaque may enable non-invasive detection of high-risk lesions. This review discusses the use of high-resolution MRI for plaque detection and characterization and the potentials of “molecular imaging”, using a variety of molecules present in atherosclerotic plaques that may serve as targets for specific contrast agents to allow the identification of high-risk atherosclerotic lesions in vivo. Ultimately, such agents may enable treatment of “high-risk” patients prior to lesion progression and the occurrence of complications, and may allow for better stratification of “high-risk” plaque and “high-risk” patients.