Within the past decade, intravascular ultrasound (IVUS) has proved to be a useful modality for guiding coronary interventions and assessment of cardiac allograft vasculopathy. During the last few years, IVUS has been used increasingly for the evaluation of the efficacy of various possible antiatherosclerotic therapies including high-dose statins, antihypertensives, and recombinant apolipoprotein A-I Milano. The recently introduced radiofrequency signal analysis is an advanced method for evaluation of IVUS signals to determine various histologic components of atherosclerotic plaques. Elastography is an allied technology for measuring the tissue strain that occurs in response to changes in intraluminal pressure. Whether radiofrequency signal analysis or elastography will become clinically useful tools for detecting vulnerable plaques remains an unanswered, burning question.