Coronary atherosclerosis is by far the most frequent cause of ischemic heart disease, and plaque disruption with superimposed thrombosis is the main cause of the acute coronary syndromes of unstable angina, myocardial infarction, and sudden death.1 2 3 4 5 Therefore, for event-free survival, the vital question is not why atherosclerosis develops but rather why, after years of indolent growth, it suddenly becomes complicated by life-threatening thrombosis. The composition and vulnerability of plaque rather than its volume or the consequent severity of stenosis produced have emerged as being the most important determinants for the development of the thrombus-mediated acute coronary syndromes; lipid-rich and soft plaques are more dangerous than collagen-rich and hard plaques because they are more unstable and rupture-prone and highly thrombogenic after disruption.6 This review will explore potential mechanisms responsible for the sudden conversion of a stable atherosclerotic plaque to an unstable and life-threatening atherothrombotic lesion—an event known as plaque fissuring, rupture, or disruption.7 8 

Atherosclerosis is the result of a complex interaction between blood elements, disturbed flow, and vessel wall abnormality, involving several pathological processes: inflammation, with increased endothelial permeability, endothelial activation, and monocyte recruitment9 10 11 12 13 14 ; growth, with smooth muscle cell (SMC) proliferation, migration, and matrix synthesis15 16 ; degeneration, with lipid accumulation17 18 ; necrosis, possibly related to the cytotoxic effect of oxidized lipid19 ; calcification/ossification, which may represent an active rather than a dystrophic process20 21 ; and thrombosis, with platelet recruitment and fibrin formation.1 22 23 Thrombotic factors may play a role early during atherogenesis, but a flow-limiting thrombus does not develop until mature plaques are present, which is why thrombosis often is classified as a complication rather than a genuine component of atherosclerosis. 

### Mature Plaques: Atherosis and Sclerosis 

As the name atherosclerosis implies, mature …

Coronary Plaque Disruption

Background—The results of studies of advanced lesions of atherosclerosis suggest that the thickness of the fibrous cap that overlies the necrotic core distinguishes the stable lesion from one that is at high risk for rupture and thromboembolic events. We have developed a high-resolution MRI technique that can identify the fine structure of the lesion, including the fibrous cap, in vivo. The aim of the present study was to determine the agreement between in vivo MRI and lesion architecture as seen on histology and gross tissue examination to identify fibrous cap thickness and rupture. Methods and Results—Twenty-two subjects who were scheduled for carotid endarterectomy underwent MRI with a 3-dimensional multiple overlapping thin slab angiography protocol. The appearance of the fibrous cap was categorized as (1) an intact, thick, (2) an intact, thin, or (3) a ruptured fibrous cap on MRI, gross, and histological sections. Thirty-six sites were available for comparison between MRI and histology. There was a h...

Visualization of Fibrous Cap Thickness and Rupture in Human Atherosclerotic Carotid Plaque In Vivo With High-Resolution Magnetic Resonance Imaging

Pattern recognition methods and applications in biomedical magnetic resonance

The present invention provides systems and methods for the evaluation of the urethra and periurethral tissues using an MRI coil adapted for insertion into the male, female or pediatric urethra. The MRI coil may be in electrical communication with an interface circuit made up of a tuning-matching circuit, a decoupling circuit and a balun circuit. The interface circuit may also be in electrical communication with a MRI machine. In certain practices, the present invention provides methods for the diagnosis and treatment of conditions involving the urethra and periurethral tissues, including disorders of the female pelvic floor, conditions of the prostate and anomalies of the pediatric pelvis.

Systems and methods for evaluating the urethra and the periurethral tissues

Potentially important diagnostic information about atherosclerosis can be obtained by using magnetic resonance imaging and spectroscopy techniques. Because critical vessels such as the aorta, coronary arteries, and renal arteries are not near the surface of the body, surface coils are not adequate to increase the data quality to desired levels. A few catheter MR receiver coil designs have been proposed for imaging the walls of large blood vessels such as the aorta. These coils have limited longitudinal coverage and they are too thick to be placed into small vessels. A flexible, long and narrow receiver coil that can be placed on the tip of a catheter and will enable multi-slice high resolution imaging of small vessels has been developed. The authors describe the theory of the coil design technique, derive formulae for the signal-to-noise ratio characteristics of the coil, and show examples of high resolution cross-sectional images from isolated human aortas acquired by using this catheter coil. In addition, high resolution in vivo rabbit aorta images were obtained as well as a set of spatially resolved chemical shift spectra from a dog circumflex coronary artery.

/pdf/high-resolution-intravascular-mri-and-mrs-by-using-a-skc9mphh1t.pdf

High resolution intravascular MRI and MRS by using a catheter receiver coil

A new medical image analysis system to quantify atherosclerosis in the lower abdominal aorta using magnetic resonance imaging is described. This medical image analysis and display system permits the quantification of the three-dimensional (3D) properties of the vessel wall and lumen cross-sectional area and volumes. Preliminary results of employing this medical image analysis capability on magnetic resonance images demonstrated a twofold increase in wall volume per unit vessel length, corresponding to intimal thickening, before luminal narrowing was detected. This work demonstrated the feasibility and usefulness of quantitatively evaluating the 3D properties of the vessel lumen and wall by using a combination of magnetic resonance imaging and image analysis. The demonstration that intimal wall thickening is observed in images before observable occlusion of the lumen can be expected to provide an important early indicator of the future development of atherosclerosis. Such capability will permit detailed and quantitative studies to assess the effectiveness of therapies, such as drug, exercise, and dietary regimens.

Noninvasive quantitative evaluation of atherosclerosis using MRI and image analysis.

This paper describes the development of a Physician's Workstation (PWS) for the evaluation of soft tissue types utilizing MR, which includes the analysis, quantification and 3-D visualization of the pertinent tissues. A major theme underlying our work is that it is possible to develop robust image processinglpattem recognition algorithms for the evaluation of diseased tissue by focusing on specific diseases involving localized regions of the body obtained with consistent and well developed imaging protocols. We have implemented two specific image processinglpattem recognition and display systems for (1) the evaluation of atherosclerosis; and (2) the differentiation of breast lesions.

https://ieeexplore.ieee.org/iel4/499/4080/00691131.pdf

Diseased Tissue Identification And Quantification Utilizing MRI

An algorithm to automatically segment the aorta from transverse MR images has been developed as part of a system to non-invasively evaluate the progression of atherosclerosis. After MR images of the abdomen are acquired, the aorta is segmented from the image. The tissues in the aorta wall are classified and the extent of each stage of the disease is quantified. A threedimensional reconstruction of the classified aorta is used to visualized the tissues in the aorta wall.

https://ieeexplore.ieee.org/iel4/499/4080/00691030.pdf

Segmentation Of The Abdominal Aorta From Transverse MR Images

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Papers

Noninvasive quantitative evaluation of atherosclerosis using MRI and image analysis.

Diseased Tissue Identification And Quantification Utilizing MRI

Segmentation Of The Abdominal Aorta From Transverse MR Images