Current Clinical Status of Vascular Non-Invasive Imaging Methodologies 1996; Libby, Ridker, & Maseri, 2002; Packard & Libby, 2008; Virmani, Burke, Farb, & Kolodgie, 2006). Eventual erosion and/or rupture of the fibrous cap expose the necrotic core to the blood stream leading to thrombus formation and abrupt closure of the vessel lumen. Several postmortem studies have confirmed the presence of plaque erosion (Farb et al., 1996) and rupture (Burke et al., 1997)in patients who presented with acute vascular events. Other characteristic features such as increased neovascularisation and macrophage accumulation especially in the shoulder region of the plaque have also been noted in ruptured plaques(Moreno et al., 2004; Muller, Abela, Nesto, & Tofler, 1994). Plaque components and hallmarks of a rupture prone plaque are summa- rized in Table 1. Assessment of coronary atherosclerosis by coronary angiography is limited since atheroscle- rotic plaques do not affect the arterial lumen measure plaque burden and function before symp- toms develop(Fayad & Fuster, 2001). Intravas- cular ultrasound, optical coherence tomography, thermography, intravascular magnetic resonance imaging and other intravascular imaging tech- niques were developed to assess the structure and function of atherosclerotic plaques early in their development when they are still confined to the arterial wall. However the techniques are invasive and can be utilised only in selected patients. Non-invasive vascular imaging modalities include magnetic resonance imaging (MRI), car- diovascular computed tomography angiography (CCTA), and nuclear imaging techniques. Until recently the primary role of non-invasive imag- ing has been to identify myocardial ischaemia in symptomatic patients and act as a gatekeeper for coronary revascularization. In this chapter we discuss in detail the various non-invasive methods used to image atherosclerosis.