Atheromatous plaques represent the most common cause of acute coronary syndrome (ACS) and sudden death. Despite significant advances in methods of managing atherosclerotic coronary plaque, it remains the leading cause of non-communicable disease-causing death in developed countries. Accurate awareness of plaque formation and pathogenesis is essential for correct interpretation of diagnostic imaging. This can be reflected in drawing appropriate management lines to save patients with ACD or reduce mortality or morbidity. In this review, we have attempted to clarify the formation and pathogenesis of plaques as well as the available visualization methods regarding their use and limitations.