2017 年 3 巻 1 号 p. 66-72
Coronary atherosclerosis with acute thrombosis is the most common cause of sudden cardiac death. Because the disruption of coronary atherosclerotic plaques triggers acute thrombosis, it is important to identify disruption-prone plaques with imaging modalities. The pathology of “plaque disruption” incudes three distinct morphologic entities: plaque rupture, plaque erosion, and calcified nodule. Currently, invasive imaging modalities such as intravascular ultrasound and intravascular optical coherence tomography can identify rupture-prone plaques, or thin-cap fibroatheromas, and calcified nodules, and unveiled that asymptomatic, multiple-plaque ruptures are a frequent complication in patients with coronary atherothrombosis. However, they cannot identify erosion-prone plaques. This article describes the morphological characteristics of coronary plaque disruptions and their possible mechanisms. In addition, the plaque imaging by nuclear medicine is discussed from a pathological viewpoint.