BACKGROUND The paradigm that atherosclerosis is just luminal stenosis has now been
superseded by work illustrating that it is a complex interplay of inflammatory processes with
vessel wall remodelling. Non-invasive cardiovascular magnetic resonance (CMR) techniques can
play an important role in providing quantitative volumetric assessment of atherosclerotic plaque
burden, identifying early atherosclerotic changes and determining the composition of plaque
constituents. We aimed to demonstrate how bulk motion artefacts can potentially lead to
deleterious quality image, how novel methods of bulk motion correction can provide better
image quality, to use a new CMR approach to characterise plaque, and apply the technique in a
novel "at risk" population through imaging of the carotid arteries.
METHODS AND RESULTS We used a novel method of detecting swallowing and established that
swallowing during image acquisition can have a profound adverse effect on image quality. We
showed that application of an accept or reject algorithm which deletes data acquired during
swallowing, improves image quality. Respiratory movement of the carotid arteries has a similar
detrimental effect on image quality but to a lesser extent and is variable between individuals. We
demonstrated that the use of an ultra-short echo time (UTE) sequence can detect areas of
calcification within plaque in ex vivo carotid artery specimens and correlated this with
computerised tomography and histological data. Finally, we showed there was a positive effect
on early atherosclerosis in patients with Behçet"s Disease treated with interferon-alpha. We
showed that this may be related to stimulation of homeostatic IgM antibodies with improved
clearance of biologically active lipids which have undergone oxidation and improvement in
endothelial function.
CONCLUSIONS Through sequence development, we have shown how bulk motion artefact can be
overcome to improve image quality of carotid artery wall imaging, and how we can further
characterise plaque constituents. Furthermore, we demonstrate how CMR of the vessel wall can
be applied in clinical trials to assess early atherosclerotic plaque burden, with novel results of the
improvement in atherosclerosis using interferon, which has not previously been described.