Noninvasive diagnosis of vulnerable coronary plaque

Table 2 Diagnostic tests for noninvasive evaluation of coronary vulnerable plaque

	CCT	CMR	PET
Plaque characterization	Plaque morphology	Plaque morphology Tissue characterization of plaque	Inflammation (FDG) Macrophage infiltration (new tracers)
Vulnerable features	Positive remodeling Low attenuation Spotty calcification Napkin-ring sign	Positive remodeling T1 hyperintensity Late gadolinium enhancement	Increased tracer uptake
Clinical relevance	Strong association with ACS Prediction of slow-flow after PCI Evaluation of response to statins	Initial data of association of T1 hyperintense plaques with slow-flow, ACS and response to statins	Differentiation between ACS and stable coronary disease
Limitations	Radiation exposure Heavy calcification Overlap in attenuation ranges Inability to detect plaque erosion	Direct relation between spatial resolution and acquisition time Susceptibility to motion artifacts	Low spatial and temporal resolution Myocardial background uptake Expensive and limited availability

CCT: Coronary computed tomography; CMR: Cardiac magnetic resonance; PET: Positron emission tomography; ACS: Acute coronary syndrome; PCI: Percutaneous coronary intervention; FDG: Fluorodeoxyglucose.