Visualization of Coronary Wall Atherosclerosis in Asymptomatic Subjects and Patients with Coronary Artery Disease Using Magnetic Resonance Imaging Suzanne C. Gerretsen 1,2 , M. Eline Kooi 1,2 , Alfons G. Kessels 3 , Simon Schalla 2,4 , Marcus Katoh 5 , Rob J. van der Geest 6 , Warren J. Manning 7 , Johannes Waltenberger 2,4 , Jos M. A. van Engelshoven 1,2 , Rene M. Botnar 8 , Tim Leiner 1,2 * ¤ 1 Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands, 2 Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands, 3 Department of Clinical Epidemiology and Medical Technical Assessment, Maastricht University Medical Center, Maastricht, The Netherlands, 4 Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands, 5 Department of Diagnostic and Interventional Radiology, Saarland University Hospital, Homburg, Germany, 6 Department of Radiology, Division of Image Processing (LKEB), Leiden University Medical Center, Leiden, The Netherlands, 7 Department of Medicine, Cardiovascular Division and Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America, 8 Imaging Sciences Division, King’s College, London, United Kingdom Abstract Background: Magnetic resonance imaging (MRI) is sensitive to early atherosclerotic changes such as positive remodeling in patients with coronary artery disease (CAD). We assessed prevalence, quality, and extent of coronary atherosclerosis in a group of healthy subjects compared to patients with confirmed CAD. Methodology: Twenty-two patients with confirmed CAD (15M, 7F, mean age 60.4610.4 years) and 26 healthy subjects without history of CAD (11M, 15F, mean age 56.164.4 years) underwent MRI of the right coronary artery (RCA) and vessel wall (MR-CVW) on a clinical 1.5T MR-scanner. Wall thickness measurements of both groups were compared. Principal Findings: Stenoses of the RCA (both , and $50% on CAG) were present in all patients. In 21/22 patients, stenoses detected at MRI corresponded to stenoses detected with conventional angiography. In 19/26 asymptomatic subjects, there was visible luminal narrowing in the MR luminography images. Fourteen of these subjects demonstrated corresponding increase in vessel wall thickness. In 4/26 asymptomatic subjects, vessel wall thickening without luminal narrowing was present. Maximum and mean wall thicknesses in patients were significantly higher (2.16 vs 1.92 mm, and 1.38 vs 1.22 mm, both p,0.05). Conclusions: In this cohort of middle-aged individuals, both patients with stable angina and angiographically proven coronary artery disease, as well as age-matched asymptomatic subjects. exhibited coronary vessel wall thickening detectable with MR coronary vessel wall imaging. Maximum and mean wall thicknesses were significantly higher in patients. The vast majority of asymptomatic subjects had either positive remodeling without luminal narrowing, or non-significant stenosis. Trial registration: ClinicalTrials.gov NCT00456950 Citation: Gerretsen SC, Kooi ME, Kessels AG, Schalla S, Katoh M, et al. (2010) Visualization of Coronary Wall Atherosclerosis in Asymptomatic Subjects and Patients with Coronary Artery Disease Using Magnetic Resonance Imaging. PLoS ONE 5(9): e12998. doi:10.1371/journal.pone.0012998 Editor: Alma Zernecke, Universita ¨t Wu ¨ rzburg, Germany Received April 26, 2010; Accepted August 31, 2010; Published September 29, 2010 This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. Funding: This work was supported by the Netherlands Organization for Scientific Research (http://www.nwo.nl/nwohome.nsf/pages/SPPD_5R2QE7_Eng; NWO VENI scheme, Grant number 916.46.034). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: timleiner@gmail.com ¤ Current address: Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands Introduction Coronary artery disease (CAD) remains the leading cause of mortality and morbidity in the Western World and developing countries despite continued improvements in prevention and early diagnosis[1,2]. The most frequent cause underlying an acute coronary event is disruption of an atherosclerotic plaque[3,4]. Rupture-prone plaques are referred to as thin-cap fibroatheroma and characterized pathologically as having a large necrotic core, high macrophage content and a thin, fibrous cap[3,4]. In asymptomatic individuals acute myocardial infarction and sudden death may be the first clinical manifestation of coronary atherosclerosis[5]. About 50–64% of all sudden cardiac deaths occur without prior recognition of coronary heart disease[1]. Well- established risk factors for coronary atherosclerosis are hypercho- lesterolaemia, hypertension, cigarette smoking, diabetes mellitus, PLoS ONE | www.plosone.org 1 September 2010 | Volume 5 | Issue 9 | e12998