B-mode ultrasound carotid intima-media thickness (IMT) measurements have increasingly proven their value as an in-vivo, non-invasive vascular research tool.

IMT can document arterial wall changes as a continuous variable, from a normal arterial wall to complete occlusion, throughout life, in groups at cardiovascular disease risk and in the unaffected.

Supported by the results of epidemiological studies and drug trials, the method can investigate the need for vascular disease prevention and evaluate cardiovascular disease risk reduction by therapeutic regimens in populations at risk.

IMT also complies with the statistical definition of a validated biomarker. Consequently, IMT is considered a truly validated surrogate endpoint for atherosclerosis progression and future and present atherosclerotic disease risk.

Presently, ultrasound arterial wall imaging studies go through a series of rapid methodological, technical and procedural developments.

The approach to imaging studies is therefore standardization so observational epidemiological and trial data become complementary. Moreover, image acquisition and administration using DICOM based trial specific application protocols, allow for regulatory compliant imaging procedures and quality assessement and quality control.

We address how and why this fascinating and elegant tool has widespread scientific and clinical applications in atherosclerosis research as well as its implications on cardiovascular disease prevention.