Fuster V
Mount Sinai Medical Center, New York, USA.
Rev Esp Cardiol. 2001;54 Suppl 1:2-7.
Magnetic resonance imaging is proving to be a very useful non-invasive imaging technique in the study of the long-term evolution of atheroma lesions. Not only is it applicable for the diagnosis of atherosclerotic disease but also for the characterization of the cellular mechanisms implied in the development of vascular damage. The four main lesions found in atherosclerosis the onset of the lesion with the appearance of remodeling, the development of vulnerable plaque, thrombus formation and the organization of the thrombus by connective tissue have been reported in detail, in both experimental animal models and in humans, from the images obtained by magnetic resonance imaging. Even though we do not yet dispose of sensitive enough methods to study the evolution of fat in coronary arteries, the high resolution images obtained in carotid or aortic plaques by magnetic resonance allow us to visualize the effect produced by statin therapy or by other protective maneuvers such as the reduction of LDL levels or the increase of HDL levels. Atherosclerotic disease must be considered as a growing tumoral process and our main goal should be to determine the degree of malignancy more than trying to quantify the stenosis. Therefore, imaging techniques constitute an essential instrument to determine the plaque characteristics, and evaluate the phase of development to thereby predict the evolution of these lesions.
磁共振成像在动脉粥样硬化病变的长期演变研究中已被证明是一种非常有用的非侵入性成像技术。它不仅适用于动脉粥样硬化疾病的诊断,还适用于表征血管损伤发展过程中所涉及的细胞机制。通过磁共振成像获得的图像,在实验动物模型和人类中,都已详细报道了动脉粥样硬化中发现的四种主要病变:病变的起始与重塑的出现、易损斑块的发展、血栓形成以及血栓由结缔组织进行机化。尽管我们尚未拥有足够灵敏的方法来研究冠状动脉中脂肪的演变,但通过磁共振在颈动脉或主动脉斑块中获得的高分辨率图像,使我们能够可视化他汀类药物治疗或其他保护性措施(如降低低密度脂蛋白水平或提高高密度脂蛋白水平)所产生的效果。动脉粥样硬化疾病必须被视为一个不断发展的肿瘤样过程,我们的主要目标应该是确定其恶性程度,而不仅仅是试图量化狭窄程度。因此,成像技术是确定斑块特征、评估病变发展阶段从而预测这些病变演变的重要工具。