Vascular imaging of atherosclerosis: Strengths and weaknesses

Atherosclerosis is an inflammatory disease that can lead to several complications such as ischemic heart disease, stroke, and peripheral vascular disease. Therefore, researchers and clinicians rely heavily on the use of imaging modalities to identify, and more recently, quantify the burden of atherosclerosis in the aorta, carotid arteries, coronary arteries, and peripheral vasculature. These imaging techniques vary in invasiveness, cost, resolution, radiation exposure, and presence of artifacts. Consequently, a detailed understanding of the risks and benefits of each technique is crucial prior to their introduction into routine cardiovascular screening. Additionally, recent research in the field of microvascular imaging has proven to be important in the field of atherosclerosis. Using techniques such as contrast-enhanced ultrasound and superb microvascular imaging, researchers have been able to detect blood vessels within a plaque lesion that may contribute to vulnerability and rupture. This paper will review the strengths and weaknesses of the various imaging techniques used to measure atherosclerotic burden. Furthermore, it will discuss the future of advanced imaging modalities as potential biomarkers for atherosclerosis.