This presentation is designed to:1. provide an introduction to the concept of atherosclerosis as an inflammatory disease.2. create awareness of some of the recent advances in the understanding of atherosclerosis as an inflammatory disease.3. outline some of the implications of the above on the practice of radiology.4. stimulate further interest in the subject amongst radiologists.

The concept of atherosclerosis as an inflammatory disease was firstpopularised by Ross in the 1990s(1). Since then, there has been countless clinical and basic science studies to support the original hypothesis. Indeed, it has been demonstrated that the degree of the inflammatory response, as measured by high-sensitivity C-reactive protein (hsCRP) levels, can be related to the risk of developing adverse atherosclerotic events(2). Inflammation is associated with all stages of atherosclerosis(1). An initial pathological insult(e.g. high cholesterol, free radicals, homocysteine) damages the arterial endothelial lining(Figure 1)....

Atherosclerosis as an inflammatory diseasehas many implications for the radiologist. Firstly, a goodunderstanding of the disease process can improve both the imaging and the identification of the vulnerable plaque. Secondly, research into the basic science of the disease may yield important gains for the endovascular treatment of atherosclerosis. Imaging of vulnerable plaque The current 'gold standard' of assessing atherosclerosis, X-ray angiography, has many weaknesses.Unfortunately, X-ray angiography only demonstrates flow in the lumen of a blood vessel and may not be able detect atherosclerosis in an...

There has been great advances in the diagnosis and treatment of the unstable plaque. The authors strongly believe that the practice of cardiovascular radiology would be revolutionised by the development of imaging modalities capable of detecting unstable atherosclerotic lesions. Indeed, it may be possible for the vascular interventionalist to prevent the clinical manifestation of acute atherosclerosis by the use of various invasive and non-invasive modalities to treat unstable atherosclerotic lesions. In addition, the utilisation of various agents aimed at reducing vascular inflammation may be useful...

(1) Ross R. Atherosclerosis- an inflammatory disease. N Engl J Med 1999; 340: 115-26(2) Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 973-79.(3) Davies MJ. Stability and instability. Two faces of coronary atherosclerosis. Circulation 1996; 94: 2013-20(4) Tan KT, Lip GY, Blann AD. Post-stroke inflammatory response: Effects on stroke evolution and outcome. Curr Atheroscler Rep 2003; 5: 245-51(5) Hodgson JM, Reddy KG, Suneja R et...

We acknowledge the support of Dr. Garrett McGann FRCR, Consultant Radiologist,Cheltenham General Hospital, U.K., in the preparation of this presentation.This presentation originates from the University of Bristol, Bristol (KT) and the Mersey Deanery, Liverpool (HA, DB).The contact details of the first andsponsoring author (K.T. Tan) are detailed below.Department of Radiology, Bristol Royal Infirmary, Bristol BS2 8HW, United Kingdom. email: [email protected]