| Summary: | Predicting the future is a fundamental requirement of cardiovascular prevention practice. Identification of individuals who we predict to be at risk of future events allows us to target interventions and potentially change the future. Cardiovascular risk scores based on modifiable factors such as cholesterol level, blood pressure, smoking history and presence of diabetes remain our simplest but most robust prediction tools1. However, alongside these traditional tools there have been consistent efforts to identify better markers, particularly through the use of imaging. Visualisation of blood vessels is potentially a powerful means to quantify directly vascular disease burden or stability. Ultrasound, CT and MR have all developed independent means to stratify risk for examples as coronary artery calcium scoring2 or carotid wall and plaque imaging3. However, many structural imaging techniques have failed to substantially modify or add to the information provided by traditional risk scores and it may be necessary to use imaging in more sophisticated ways.
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