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MR and PET vessel wall imaging have progressed substantially in the past decade and considerable technical improvements have been made in image acquisition and the development of cell and protein specific contrast agents that allow plaque characterization both on a morphological and molecular/cellular level. Studies in animal models of experimental atherosclerosis and small single center pilot clinical studies have demonstrated the feasibility of molecular MR and PET vessel wall imaging in the carotid artery, the aorta and the coronary arteries. These studies demonstrate the potential of those techniques for the non-invasive quantification of plaque burden and molecular composition, which could lead to improved risk stratification in patients with cardiovascular disease. With the advent of PET/MRI and continued development of target specific contrast agents, these novel techniques have potential to be useful for the non-invasive assessment of atherosclerosis and for monitoring response to treatment in clinical practice.