Skip to main content
SpringerLink
Log in

Atherosclerosis Imaging

  • Chapter
  • First Online:
FDG-PET/CT and PET/MR in Cardiovascular Diseases

  • 316 Accesses

Abstract

Atherosclerotic cardiovascular disease accounts for a large burden of morbidity and mortality. Insights over the past several decades have dramatically shifted our understanding of atherosclerosis from a bland luminal narrowing to a dynamic process driven by active inflammation and other pathobiological processes. Over the past 20 years, noninvasive molecular imaging techniques targeting atherosclerosis have evolved to provide measures of disease activity, structure, and disease burden, several of which are now employed to inform clinical decision-making. Additionally, such imaging techniques are being leveraged to derive insights into several cardiovascular disease mechanisms. This chapter focuses on noninvasive molecular imaging modalities that assess atherosclerosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Barquera S, Pedroza-Tobías A, Medina C, Hernández-Barrera L, Bibbins-Domingo K, Lozano R, et al. Global overview of the epidemiology of atherosclerotic cardiovascular disease. Arch Med Res. 2015;46(5):328–38.

    Article  PubMed  Google Scholar 

  2. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105(9):1135–43.

    Article  CAS  PubMed  Google Scholar 

  3. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340(2):115–26.

    Article  CAS  PubMed  Google Scholar 

  4. Kuiper J, van Puijvelde GHM, van Wanrooij EJA, van Es T, Habets K, Hauer AD, et al. Immunomodulation of the inflammatory response in atherosclerosis. Curr Opin Lipidol. 2007 Oct;18(5):521–6.

    Article  CAS  PubMed  Google Scholar 

  5. Tabas I, García-Cardeña G, Owens GK. Recent insights into the cellular biology of atherosclerosis. J Cell Biol. 2015;209(1):13–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Joseph P, Tawakol A. Imaging atherosclerosis with positron emission tomography. Eur Heart J. 2016;37(39):2974–80.

    Article  PubMed  Google Scholar 

  7. Libby P. Inflammation in atherosclerosis. Arterioscler Thromb Vasc Biol. 2012;32(9):2045–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Burke AP, Tracy RP, Kolodgie F, Malcom GT, Zieske A, Kutys R, et al. Elevated C-reactive protein values and atherosclerosis in sudden coronary death: association with different pathologies. Circulation. 2002;105(17):2019–23.

    Article  CAS  PubMed  Google Scholar 

  9. Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA. 2007;297(6):611–9.

    Article  CAS  PubMed  Google Scholar 

  10. Ridker PM, Danielson E, Fonseca FAH, Genest J, Gotto AM Jr, Kastelein JJP, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195–207.

    Article  CAS  PubMed  Google Scholar 

  11. Geovanini GR, Libby P. Atherosclerosis and inflammation: overview and updates. Clin Sci (Lond). 2018;132(12):1243–52.

    Article  CAS  Google Scholar 

  12. Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, et al. C-reactive protein levels and outcomes after statin therapy. N Engl J Med. 2005;352(1):20–8.

    Article  CAS  PubMed  Google Scholar 

  13. Bohula EA, Giugliano RP, Cannon CP, Zhou J, Murphy SA, White JA, et al. Achievement of dual low-density lipoprotein cholesterol and high-sensitivity C-reactive protein targets more frequent with the addition of ezetimibe to simvastatin and associated with better outcomes in IMPROVE-IT. Circulation. 2015;132(13):1224–33.

    Article  CAS  PubMed  Google Scholar 

  14. Ridker PM. Clinician’s guide to reducing inflammation to reduce atherothrombotic risk: JACC review topic of the week. J Am Coll Cardiol. 2018;72(25):3320–31.

    Article  PubMed  Google Scholar 

  15. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3168–209.

    Article  PubMed  Google Scholar 

  16. Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, et al. Antiinflammatory therapy with Canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119–31.

    Article  CAS  PubMed  Google Scholar 

  17. Ridker PM, Libby P, MacFadyen JG, Thuren T, Ballantyne C, Fonseca F, et al. Modulation of the interleukin-6 signalling pathway and incidence rates of atherosclerotic events and all-cause mortality: analyses from the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS). Eur Heart J. 2018;39(38):3499–507.

    Article  CAS  PubMed  Google Scholar 

  18. Tardif J-C, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019;381(26):2497–505.

    Article  CAS  PubMed  Google Scholar 

  19. Fischer BG. Colchicine in patients with chronic coronary disease. N Engl J Med. 2021;384(8):777.

    PubMed  Google Scholar 

  20. Tawakol A, Singh P, Mojena M, Pimentel-Santillana M, Emami H, MacNabb M, et al. HIF-1α and PFKFB3 mediate a tight relationship between proinflammatory activation and anerobic metabolism in atherosclerotic macrophages. Arterioscler Thromb Vasc Biol. 2015;35(6):1463–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Rudd JHF, Warburton EA, Fryer TD, Jones HA, Clark JC, Antoun N, et al. Imaging atherosclerotic plaque inflammation with [18F]-fluorodeoxyglucose positron emission tomography. Circulation. 2002;105(23):2708–11.

    Article  CAS  PubMed  Google Scholar 

  22. Osborne MT, Abohashem S, Zureigat H, Abbasi TA, Tawakol A. Multimodality molecular imaging: gaining insights into the mechanisms linking chronic stress to cardiovascular disease. J Nucl Cardiol. 2021;28(3):955–66.

    Article  PubMed  Google Scholar 

  23. Bural GG, Torigian DA, Chamroonrat W, Houseni M, Chen W, Basu S, et al. FDG-PET is an effective imaging modality to detect and quantify age-related atherosclerosis in large arteries. Eur J Nucl Med Mol Imaging. 2008;35(3):562–9.

    Article  PubMed  Google Scholar 

  24. Joly L, Djaballah W, Koehl G, Mandry D, Dolivet G, Marie P-Y, et al. Aortic inflammation, as assessed by hybrid FDG-PET/CT imaging, is associated with enhanced aortic stiffness in addition to concurrent calcification. Eur J Nucl Med Mol Imaging. 2009;36(6):979–85.

    Article  PubMed  Google Scholar 

  25. Rudd JHF, Myers KS, Bansilal S, Machac J, Woodward M, Fuster V, et al. Relationships among regional arterial inflammation, calcification, risk factors, and biomarkers: a prospective fluorodeoxyglucose positron-emission tomography/computed tomography imaging study. Circ Cardiovasc Imaging. 2009;2(2):107–15.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kim TN, Kim S, Yang SJ, Yoo HJ, Seo JA, Kim SG, et al. Vascular inflammation in patients with impaired glucose tolerance and type 2 diabetes: analysis with 18F-fluorodeoxyglucose positron emission tomography. Circ Cardiovasc Imaging. 2010;3(2):142–8.

    Article  PubMed  Google Scholar 

  27. Rogers IS, Tawakol A. Imaging of coronary inflammation with FDG-PET: feasibility and clinical hurdles. Curr Cardiol Rep. 2011;13(2):138–44.

    Article  PubMed  Google Scholar 

  28. Tawakol A, Migrino RQ, Bashian GG, Bedri S, Vermylen D, Cury RC, et al. In vivo 18F-fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflammation in patients. J Am Coll Cardiol. 2006;48(9):1818–24.

    Article  PubMed  Google Scholar 

  29. Rudd JHF, Myers KS, Bansilal S, Machac J, Rafique A, Farkouh M, et al. (18)Fluorodeoxyglucose positron emission tomography imaging of atherosclerotic plaque inflammation is highly reproducible: implications for atherosclerosis therapy trials. J Am Coll Cardiol. 2007;50(9):892–6.

    Article  PubMed  Google Scholar 

  30. Figueroa AL, Abdelbaky A, Truong QA, Corsini E, MacNabb MH, Lavender ZR, et al. Measurement of arterial activity on routine FDG PET/CT images improves prediction of risk of future CV events. JACC Cardiovasc Imaging. 2013;6(12):1250–9.

    Article  PubMed  Google Scholar 

  31. Tawakol A, Ishai A, Takx RA, Figueroa AL, Ali A, Kaiser Y, et al. Relation between resting amygdalar activity and cardiovascular events: a longitudinal and cohort study. Lancet. 2017;389(10071):834–45.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Rominger A, Saam T, Wolpers S, Cyran CC, Schmidt M, Foerster S, et al. 18F-FDG PET/CT identifies patients at risk for future vascular events in an otherwise asymptomatic cohort with neoplastic disease. J Nucl Med. 2009;50(10):1611–20.

    Article  PubMed  Google Scholar 

  33. Cocker MS, Spence JD, Hammond R, deKemp RA, Lum C, Wells G, et al. [18F]-Fluorodeoxyglucose PET/CT imaging as a marker of carotid plaque inflammation: comparison to immunohistology and relationship to acuity of events. Int J Cardiol. 2018;271:378–86.

    Article  PubMed  Google Scholar 

  34. Cheng VY, Slomka PJ, Le Meunier L, Tamarappoo BK, Nakazato R, Dey D, et al. Coronary arterial 18F-FDG uptake by fusion of PET and coronary CT angiography at sites of percutaneous stenting for acute myocardial infarction and stable coronary artery disease. J Nucl Med. 2012;53(4):575–83.

    Article  CAS  PubMed  Google Scholar 

  35. Tawakol A, Fayad ZA, Mogg R, Alon A, Klimas MT, Dansky H, et al. Intensification of statin therapy results in a rapid reduction in atherosclerotic inflammation: results of a multicenter fluorodeoxyglucose-positron emission tomography/computed tomography feasibility study. J Am Coll Cardiol. 2013;62(10):909–17.

    Article  CAS  PubMed  Google Scholar 

  36. Mizoguchi M, Tahara N, Tahara A, Nitta Y, Kodama N, Oba T, et al. Pioglitazone attenuates atherosclerotic plaque inflammation in patients with impaired glucose tolerance or diabetes a prospective, randomized, comparator-controlled study using serial FDG PET/CT imaging study of carotid artery and ascending aorta. JACC Cardiovasc Imaging. 2011;4(10):1110–8.

    Article  PubMed  Google Scholar 

  37. Emami H, Vucic E, Subramanian S, Abdelbaky A, Fayad ZA, Du S, et al. The effect of BMS-582949, a P38 mitogen-activated protein kinase (P38 MAPK) inhibitor on arterial inflammation: a multicenter FDG-PET trial. Atherosclerosis. 2015;240(2):490–6.

    Article  CAS  PubMed  Google Scholar 

  38. STABILITY Investigators, White HD, Held C, Stewart R, Tarka E, Brown R, et al. Darapladib for preventing ischemic events in stable coronary heart disease. N Engl J Med. 2014;370(18):1702–11.

    Article  Google Scholar 

  39. O’Donoghue ML, Glaser R, Cavender MA, Aylward PE, Bonaca MP, Budaj A, et al. Effect of Losmapimod on cardiovascular outcomes in patients hospitalized with acute myocardial infarction: a randomized clinical trial. JAMA. 2016;315(15):1591–9.

    Article  PubMed  Google Scholar 

  40. Schwartz GG, Olsson AG, Abt M, Ballantyne CM, Barter PJ, Brumm J, et al. Effects of dalcetrapib in patients with a recent acute coronary syndrome. N Engl J Med. 2012;367(22):2089–99.

    Article  CAS  PubMed  Google Scholar 

  41. Tawakol A, Singh P, Rudd JHF, Soffer J, Cai G, Vucic E, et al. Effect of treatment for 12 weeks with rilapladib, a lipoprotein-associated phospholipase A2 inhibitor, on arterial inflammation as assessed with 18F-fluorodeoxyglucose-positron emission tomography imaging. J Am Coll Cardiol. 2014;63(1):86–8.

    Article  CAS  PubMed  Google Scholar 

  42. Wykrzykowska J, Lehman S, Williams G, Parker JA, Palmer MR, Varkey S, et al. Imaging of inflamed and vulnerable plaque in coronary arteries with 18F-FDG PET/CT in patients with suppression of myocardial uptake using a low-carbohydrate, high-fat preparation. J Nucl Med. 2009;50(4):563–8.

    Article  PubMed  Google Scholar 

  43. Rogers IS, Nasir K, Figueroa AL, Cury RC, Hoffmann U, Vermylen DA, et al. Feasibility of FDG imaging of the coronary arteries: comparison between acute coronary syndrome and stable angina. JACC Cardiovasc Imaging. 2010;3(4):388–97.

    Article  PubMed  Google Scholar 

  44. Singh P, Emami H, Subramanian S, Maurovich-Horvat P, Marincheva-Savcheva G, Medina HM, et al. Coronary plaque morphology and the anti-inflammatory impact of Atorvastatin: a multicenter 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic study. Circ Cardiovasc Imaging. 2016;9(12):e004195.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Galiuto L, Leccisotti L, Locorotondo G, Porto I, Burzotta F, Trani C, et al. Coronary plaque instability assessed by positron emission tomography and optical coherence tomography. Ann Nucl Med. 2021;35(10):1136–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Tarkin JM, Joshi FR, Evans NR, Chowdhury MM, Figg NL, Shah AV, et al. Detection of atherosclerotic inflammation by68Ga-DOTATATE PET compared to [18F]FDG PET imaging. J Am Coll Cardiol. 2017;69(14):1774–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Mateo J, Izquierdo-Garcia D, Badimon JJ, Fayad ZA, Fuster V. Noninvasive assessment of hypoxia in rabbit advanced atherosclerosis using 18F-fluoromisonidazole PET imaging. Circ Cardiovasc Imaging. 2014;7(2):312–20.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Paeng JC, Lee Y-S, Lee JS, Jeong JM, Kim K-B, Chung J-K, et al. Feasibility and kinetic characteristics of (68)Ga-NOTA-RGD PET for in vivo atherosclerosis imaging. Ann Nucl Med. 2013;27(9):847–54.

    Article  CAS  PubMed  Google Scholar 

  49. Beer AJ, Pelisek J, Heider P, Saraste A, Reeps C, Metz S, et al. PET/CT imaging of integrin αvβ3 expression in human carotid atherosclerosis. JACC Cardiovasc Imaging. 2014;7(2):178–87.

    Article  PubMed  Google Scholar 

  50. Teague HL, Ahlman MA, Alavi A, Wagner DD, Lichtman AH, Nahrendorf M, et al. Unraveling vascular inflammation: from immunology to imaging. J Am Coll Cardiol. 2017;70(11):1403–12.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Dweck MR, Chow MWL, Joshi NV, Williams MC, Jones C, Fletcher AM, et al. Coronary arterial 18F-sodium fluoride uptake: a novel marker of plaque biology. J Am Coll Cardiol. 2012;59(17):1539–48.

    Article  CAS  PubMed  Google Scholar 

  52. Wang Y, Osborne MT, Tung B, Li M, Li Y. Imaging cardiovascular calcification. J Am Heart Assoc. 2018;7(13):e008564.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Dweck MR, Aikawa E, Newby DE, Tarkin JM, Rudd JHF, Narula J, et al. Noninvasive molecular imaging of disease activity in atherosclerosis. Circ Res. 2016;119(2):330–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Kwiecinski J, Tzolos E, Adamson PD, Cadet S, Moss AJ, Joshi N, et al. Coronary 18F-sodium fluoride uptake predicts outcomes in patients with coronary artery disease. J Am Coll Cardiol. 2020;75(24):3061–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Delgado V, Saraste A, Dweck M, Bucciarelli-Ducci C, Bax JJ. Multimodality imaging: Bird’s eye view from the European Society of Cardiology Congress 2019 Paris, August 31st–September 4th, 2019. J Nucl Cardiol. 2020;27(1):53–61.

    Article  PubMed  Google Scholar 

  56. Chowdhury MM, Tarkin JM, Albaghdadi MS, Evans NR, Le EPV, Berrett TB, et al. Vascular positron emission tomography and restenosis in symptomatic peripheral arterial disease. JACC Cardiovasc Imaging. 2020;13(4):1008–17.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Forsythe RO, Dweck MR, McBride OMB, Vesey AT, Semple SI, Shah ASV, et al. 18F-sodium fluoride uptake in abdominal aortic aneurysms: the SoFIA3Study. J Am Coll Cardiol. 2018;71(5):513–23.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Joshi NV, Vesey AT, Williams MC, Shah ASV, Calvert PA, Craighead FHM, et al. 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet. 2014;383(9918):705–13.

    Article  PubMed  Google Scholar 

  59. Ripa RS, Pedersen SF, Kjær A. PET/MR imaging in vascular disease: atherosclerosis and inflammation. PET Clin. 2016;11(4):479–88.

    Article  PubMed  Google Scholar 

  60. Robson PM, Dweck MR, Trivieri MG, Abgral R, Karakatsanis NA, Contreras J, et al. Coronary artery PET/MR imaging: feasibility, limitations, and solutions. JACC Cardiovasc Imaging. 2017;10(10 Pt A):1103–12.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Calcagno C, Lairez O, Hawkins J, Kerr SW, Dugas MS, Simpson T, et al. Combined PET/DCE-MRI in a rabbit model of atherosclerosis: integrated quantification of plaque inflammation, permeability, and burden during treatment with a leukotriene A4 hydrolase inhibitor. JACC Cardiovasc Imaging. 2018;11(2 Pt 2):291–301.

    Article  PubMed  Google Scholar 

  62. Senders ML, Hernot S, Carlucci G, van de Voort JC, Fay F, Calcagno C, et al. Nanobody-facilitated multiparametric PET/MRI phenotyping of atherosclerosis. JACC Cardiovasc Imaging. 2019;12(10):2015–26.

    Article  PubMed  Google Scholar 

  63. Dutta P, Courties G, Wei Y, Leuschner F, Gorbatov R, Robbins C, et al. Myocardial infarction accelerates atherosclerosis. Nature. 2012;487(7407):325–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Emami H, Singh P, MacNabb M, Vucic E, Lavender Z, Rudd JHF, et al. Splenic metabolic activity predicts risk of future cardiovascular events: demonstration of a cardiosplenic axis in humans. JACC Cardiovasc Imaging. 2015;8(2):121–30.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Ye Y-X, Calcagno C, Binderup T, Courties G, Keliher EJ, Wojtkiewicz GR, et al. Imaging macrophage and hematopoietic progenitor proliferation in atherosclerosis. Circ Res. 2015;117(10):835–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Batty GD, Russ TC, Stamatakis E, Kivimäki M. Psychological distress and risk of peripheral vascular disease, abdominal aortic aneurysm, and heart failure: pooling of sixteen cohort studies. Atherosclerosis. 2014;236(2):385–8.

    Article  CAS  PubMed  Google Scholar 

  67. Nabi H, Kivimäki M, Batty GD, Shipley MJ, Britton A, Brunner EJ, et al. Increased risk of coronary heart disease among individuals reporting adverse impact of stress on their health: the Whitehall II prospective cohort study. Eur Heart J. 2013;34(34):2697–705.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Dejaco C, Ramiro S, Duftner C, Besson FL, Bley TA, Blockmans D, et al. EULAR recommendations for the use of imaging in large vessel vasculitis in clinical practice. Ann Rheum Dis. 2018;77(5):636–43.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Azar Radfar, Michael T. Osborne & Ahmed Tawakol

  2. Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Shady Abohashem, Michael T. Osborne & Ahmed Tawakol

Authors
  1. Azar Radfar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shady Abohashem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael T. Osborne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmed Tawakol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed Tawakol .

Editor information

Editors and Affiliations

  1. Montreal Heart Institute, Montréal, QC, Canada

    Matthieu Pelletier-Galarneau

  2. BC Cancer Agency, Vancouver, BC, Canada

    Patrick Martineau

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Radfar, A., Abohashem, S., Osborne, M.T., Tawakol, A. (2022). Atherosclerosis Imaging. In: Pelletier-Galarneau, M., Martineau, P. (eds) FDG-PET/CT and PET/MR in Cardiovascular Diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-09807-9_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-09807-9_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-09806-2

  • Online ISBN: 978-3-031-09807-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation