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STATE-OF-THE-ART PAPER

Radionuclide Imaging

A Molecular Key to the Atherosclerotic Plaque

Harald F. Langer, MD^_*,_*, Roland Haubner, PhD, Bernd J. Pichler, PhD and Meinrad Gawaz, MD^_*

^_* Medizinische Klinik III, Eberhard Karls Universität Tübingen, Tübingen, Germany
Universitätsklinik für Nuklearmedizin, Medizinische Universität Innsbruck, Innsbruck, Austria
Laboratory for Preclinical Imaging and Imaging Technology, Clinic of Radiology, University of Tübingen, Tübingen, Germany.

Manuscript received January 18, 2008; revised manuscript received March 20, 2008, accepted March 24, 2008.

^_* Reprint requests and correspondence: Dr. Harald Langer, Medizinische Klinik III, Eberhard Karls Universität Tübingen, Otfried-Müllerstr. 10, 72076 Tübingen, Germany. E-mail: harald.langer@med.uni-tuebingen.de; currently affiliated with National Institute of Health/National Cancer Institute, Building 10, Room 5B17, Bethesda, Maryland 20852. (Email: langerh{at}mail.nih.gov).

Despite primary and secondary prevention, serious cardiovascular events such as unstable angina or myocardial infarction still account for one-third of all deaths worldwide. Therefore, identifying individual patients with vulnerable plaques at high risk for plaque rupture is a central challenge in cardiovascular medicine. Several noninvasive techniques, such as magnetic resonance imaging, multislice computed tomography, and electron beam tomography are currently being tested for their ability to identify such patients by morphological criteria. In contrast, molecular imaging techniques use radiolabeled molecules to detect functional aspects in atherosclerotic plaques by visualizing their biological activity. Based upon the knowledge about the pathophysiology of atherosclerosis, various studies in vitro and in vivo and the first clinical trials have used different tracers for plaque imaging studies, including radioactive-labeled lipoproteins, components of the coagulation system, cytokines, mediators of the metalloproteinase system, cell adhesion receptors, and even whole cells. This review gives an update on the relevant noninvasive plaque imaging approaches using nuclear imaging techniques to detect atherosclerotic vascular lesions.

Key Words: plaque imaging • atherosclerosis • radionuclide imaging • vulnerable plaque • thrombogenicity

Abbreviations and Acronyms   ApoE = apolipoprotein E   CT = computed tomography   FCH = fluorocholine   FDG = fluorodeoxyglucose   GPVI = glycoprotein VI   LDL = low-density lipoprotein   MCP = monocyte chemoattractant protein   MDA2 = malondialdehyde epitope on oxidized low-density lipoprotein   MMP = matrix metalloproteinase   MRI = magnetic resonance imaging   MSCT = multislice computed tomography   NIRF = near-infrared fluorescent   ox-LDL = oxidized low-density lipoprotein   PET = positron emission tomography   RGD = protein sequence "arginine-glycine-aspartic acid"   SPECT = single-photon emission computed tomography

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