Schaar Johannes A, van der Steen Anton F W, Mastik Frits, Baldewsing Radj A, Serruys Patrick W
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
J Am Coll Cardiol. 2006 Apr 18;47(8 Suppl):C86-91. doi: 10.1016/j.jacc.2006.01.035.
Palpography assesses the local mechanical properties of tissue using the deformation caused by the intraluminal pressure. The technique was validated in vitro using diseased human coronary and femoral arteries. Especially between fibrous and fatty tissue, a highly significant difference in strain (p = 0.0012) was found. Additionally, the predictive value to identify the vulnerable plaque was investigated. A high-strain region at the lumen vessel wall boundary has 88% sensitivity and 89% specificity for identifying these plaques. In vivo, the technique is validated in an atherosclerotic Yucatan minipig animal model. This study also revealed higher strain values in fatty than in fibrous plaques (p < 0.001). The presence of a high-strain region at the lumen-plaque interface has a high predictive value to identify macrophages. Patient studies revealed high strain values (1% to 2%) in noncalcified plaques. Calcified material showed low strain values (0% to 0.2%). With the development of three-dimensional palpography, identification of weak spots over the full length of a coronary artery becomes available. Patients with myocardial infarction or unstable angina have more high-strain spots in their coronary arteries than patients with stable angina. In conclusion, intravascular palpography is a unique tool to assess lesion composition and vulnerability. Three-dimensional palpography provides a technique that may develop into a clinically available tool for decision making to treat hemodynamically nonsignificant lesions by identifying vulnerable plaques. The clinical utility of this technique is yet to be determined, and more investigation is needed.
触诊成像利用腔内压力引起的组织变形来评估组织的局部力学特性。该技术在体外使用病变的人类冠状动脉和股动脉进行了验证。特别是在纤维组织和脂肪组织之间，发现应变存在高度显著差异（p = 0.0012）。此外，还研究了识别易损斑块的预测价值。管腔血管壁边界处的高应变区域识别这些斑块的敏感性为88%，特异性为89%。在体内，该技术在动脉粥样硬化的尤卡坦小型猪动物模型中得到验证。这项研究还显示，脂肪斑块中的应变值高于纤维斑块（p < 0.001）。管腔-斑块界面处高应变区域的存在对识别巨噬细胞具有较高的预测价值。患者研究显示，非钙化斑块中的应变值较高（1%至2%）。钙化物质的应变值较低（0%至0.2%）。随着三维触诊成像技术的发展，可以在冠状动脉全长范围内识别薄弱点。心肌梗死或不稳定型心绞痛患者冠状动脉中的高应变点比稳定型心绞痛患者更多。总之，血管内触诊成像是评估病变组成和易损性的独特工具。三维触诊成像提供了一种技术，该技术可能发展成为一种临床可用工具，通过识别易损斑块来决定是否治疗血流动力学上无显著意义的病变。该技术的临床实用性尚待确定，还需要更多的研究。
