Figure 3 Imaging of adverse plaque characteristics Figure 3 | Imaging of adverse plaque characteristics. a | Coronary CT angiogram demonstrating an atherosclerotic plaque with evidence of positive remodelling and b | low-attenuation necrotic core. c | Magnetic resonance image demonstrating high-intensity signal on T1-weighted imaging (arrow), d | localizing to the left anterior descending coronary artery after co-registration with magnetic resonance angiogram. e | Virtual histology intravascular ultrasonography of coronary plaque with evidence of necrotic core (red areas), minimal fibrous tissue (green), and spotty calcification (white). f | Optical coherence tomography of ruptured coronary plaque (red arrow) with luminal thrombus (white arrow). g | Near-infrared spectroscopy–intravascular ultrasonography of lipid-rich coronary plaque (yellow signal corresponds to underlying lipid-rich regions). h | Plaques with adverse characteristics seldom occur in isolation and often affect multiple coronary territories simultaneously. i | Many plaques will heal while new vulnerable lesions develop. j | During the course of this dynamic disease process, one such plaque might rupture and cause a myocardial infarction. Therefore, individual vulnerable plaques might themselves be unlikely to cause events, but their detection can identify vulnerable patients at increased risk of myocardial infarction. Panels c and d reprinted from Noguchi, T. et al. High-intensity signals in coronary plaques on noncontrast T1-weighted magnetic resonance imaging as a novel determinant of coronary events. J. Am. Coll. Cardiol. 63 (10), 989–999 © (2014), with permission from Elsevier. Panel f adapted by permission from BMJ Publishing Group Limited from Adamson, P. D., Dweck, M. R. & Newby, D. E. The vulnerable atherosclerotic plaque: in vivo identification and potential therapeutic avenues. Heart 101 (21), 1755–1766 © (2015). Panels c and d reprinted from Noguchi, T. et al. High-intensity signals in coronary plaques on noncontrast T1‑weighted magnetic resonance imaging as a novel determinant of coronary events. J. Am. Coll. Cardiol. 63 (10), 989–999 © (2014), with permission from Elsevier. Panel f adapted by permission from BMJ Publishing Group Limited from Adamson, P. D., Dweck, M. R. & Newby, D. E. The vulnerable atherosclerotic plaque: in vivo identification and potential therapeutic avenues. Heart 101 (21), 1755–1766 © (2015) Dweck, M. R. et al. (2016) Imaging of coronary atherosclerosis — evolution towards new treatment strategies Nat. Rev. Cardiol. doi:10.1038/nrcardio.2016.79