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The pathobiology of the vessel wall: Implications for imaging

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Journal of Nuclear Cardiology Aims and scope

Conclusion

Recent advances in molecular and cell biology have enhanced our understanding of the vascular pathophysiology, leading to the development of many novel therapeutic approaches. However, this progress has been much less represented in our diagnostic approaches to vascular disease, which remains a major cause of morbidity and mortality, not only in developed, but also in developing, countries. A number of factors, some inherent to the vessel wall, impede progress in this direction. The vessel wall is relatively small, less than 1-mm thick (limit of resolution for nuclear imaging) in many cases. The endothelium, the most natural and easily accessible target for imaging given its presence at the interface of the bloodstream and vessel wall, is only 10- to 12-μm thick. Technical challenges raised by the target size are augmented by cardiac motion. As such, any single-modality imaging may lack many technical requirements, and successful vascular imaging may depend on hybrid and/or intravascular imaging. Enhanced uptake, detected by molecular imaging as a hot spot, will need to have an anatomic coregistration system, such as computed tomography or magnetic resonance imaging angiography. Species-specific differences in pathology, prevalent in the case of vascular disease, render translation from animal studies to human beings more difficult and unpredictable. Thus, the challenges facing vascular imagers are enormous, both biological and technical. What is (are) the best imaging target(s) for different phases of the disease? Which animal model best represent the human pathology? Can we start with a stationary target (eg, carotid artery) and then move to coronaries? Can we image coronary arteries noninvasively? Do we need to localize the diseased coronary segment or is the detection of a hot spot sufficient? What is the role of intravascular detection and/or imaging? In the presence of, and perhaps despite, these challenges, improved understanding of the vessel wall biology continues to support the identification and validation of novel molecular imaging targets (or combination of targets) (Table 2), and ultimately will lead to the development of novel diagnostic approaches for the most common vasculopathies.

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Authors and Affiliations

  1. Raymond and Beverly Sackler Cardiovascular Molecular Imaging Laboratory, Section of Cardiovascular Medicine, Yale University School of Medicine, 950 Campbell Ave, 111B, 06516, New Haven, Conn

    Mehran M. Sadeghi

  2. VA Connecticut Healthcare System, 950 Campbell Ave, 111B, 06516, West Haven, Conn.

    Mehran M. Sadeghi

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  1. Mehran M. Sadeghi
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Correspondence to Mehran M. Sadeghi.

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Supported by grants from the National Institutes of Health (P01 HL70295-01), American Heart Association (0435053), and Department of Veterans Affairs.

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Sadeghi, M.M. The pathobiology of the vessel wall: Implications for imaging. J Nucl Cardiol 13, 402–414 (2006). https://doi.org/10.1016/j.nuclcard.2006.03.012

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