Capping it off

Excerpt

Atherosclerosis progresses silently for decades before producing sudden catastrophic clinical events. During the late preclinical phase, when there is no end organ damage, there can be major savings in terms of health care costs and a major reduction in morbidity and mortality, if lesions likely to produce a clinical event can be identified and treated. Indirect measures of inflammation, such as C-reactive protein (CRP), are often employed as an indicator of risk for cardiovascular events.1 Although CRP is sensitive, it is not very specific. Adding other measurements, such as circulating levels of monocyte/macrophage colony stimulating factor (MCSF) increases the predictive value of the assays to identify patients at risk for major cardiovascular events.2 To determine the specific organs at risk, it is necessary to add an imaging procedure to survey the vasculature. Over the past 20 years, criteria to identify atheroma, especially in the carotid arteries, have been developed using multiple modalities, including magnetic resonance imaging,3 computed tomography,4 intravascular ultrasound,5 and radionuclide imaging.6 The clinical challenge, however, is not just localizing the disease, but characterizing the lesion. Several radiopharmaceuticals have been designed to localize in atheroma based on specific attributes of the lesion.7,8 The distribution of these agents can be readily depicted on combined images of anatomy and pathophysiology with hybrid PET-CT, SPECT-CT, or fusion with magnetic resonance images.9 …