The disruption of atherosclerotic plaques and subsequent formation of thrombi are currently recognized as the major cause of morbidity and mortality in cardiovascular diseases, including acute coronary syndrome and ischemic stroke. Several imaging modalities have shown promise as potential assessments of surrogate markers for atherosclerosis, and they may help clinicians/investigators to visualize atherosclerotic plaque burden, refine cardiovascular risk assessments, and allow serial monitoring of disease burden once interventions have been initiated.

Conventional imaging of atherosclerosis is based on the degree of luminal stenosis and morphologic characteristics of atheromas, including X-ray contrast angiography, computed tomography (CT) and magnetic resonance (MR) imaging. Multi-slice CT angiography is widely used to evaluate luminal stenosis and vascular walls. However, it is not suitable in heavily calcified or post-stenting lesions, or patients with renal insufficiency or arrhythmias (in coronary arteries). MR imaging could provide good spatial resolution and tissue characterization in the carotid plaques. The application of nanotechnology offers new approaches to design MR imaging agents. Nuclear imaging also has ability to non-invasively image pathophysiological process of atherosclerosis. Many radio-labeled tracers have been reported to image features of the vulnerable plaques, such as oxidized LDL accumulation and apoptosis. Recent studies have shown that 18F-fluorodeoxyglucose (FDG) accumulates in macrophage-rich plaques and positron emission tomography (PET) is useful to identify and measure inflammatory activity of individual plaques. In addition, hybrid PET/CT scanners could detect calcification and provide better localization of plaques, but still limited in coronary arteries. Intravascular ultrasound (IVUS) could quantify plaque volume and components precisely. Its high reproducibility allows accurately detecting serial changes in plaque burden; nevertheless it is invasive and limits its application.
Good plaque imaging modalities allow to screen, diagnose or monitor treatment response in patients with atherosclerosis. Several large-scale, well-controlled primary and secondary prevention clinical trials have demonstrated that statin could reduce morbidity and mortality from major cardiovascular events. Intensive lipid management is particularly important in patients with multiple cardiovascular risk factors. We will review effects of statin on atherosclerotic burden by using different imaging modalities.