Langer Harald, Schönberger Tanja, Bigalke Boris, Gawaz Meinrad
Medizinische Klinik III, Universitätsklinikum Tübingen, Tübingen, Germany.
Semin Thromb Hemost. 2007 Mar;33(2):151-8. doi: 10.1055/s-2007-969028.
Serious cardiovascular events frequently arise from rupture of vulnerable atherosclerotic plaques. Not infrequently, these plaques are clinically silent and suddenly cause acute complications such as myocardial infarction, which in a high percentage are fatal. Thus, identifying individual patients with vulnerable plaques at high risk for plaque rupture is a central challenge in clinical medicine. This review highlights noninvasive scintigraphic techniques, which use radiolabeled molecules to detect functional aspects in atherosclerotic plaques by visualizing their biological activity. One major principle is the molecular imaging of inflammation with radionuclide tracers, including detection of metabolic activity, chemotaxis, cell recruitment, and lipoprotein enrichment. Additional studies focus on visualization of apoptosis, angiogenesis, or proteolysis. A central feature of plaque vulnerability is its thrombogenicity. Therefore, detection of thrombogenic plaques is another promising principle of molecular imaging. If a reliable protocol to image vulnerable plaques, which are prone to rupture, can be established and introduced into clinical practice, the required measures such as atheroprotective medication or revascularization could be undertaken to prevent serious cardiovascular events.
严重心血管事件常因易损动脉粥样硬化斑块破裂所致。这些斑块在临床上常常毫无症状，却会突然引发急性并发症，如心肌梗死，其中很大比例是致命的。因此，识别出具有斑块破裂高风险的易损斑块个体患者是临床医学的核心挑战。本综述重点介绍了非侵入性闪烁成像技术，该技术通过可视化动脉粥样硬化斑块的生物活性，利用放射性标记分子来检测其功能方面。一个主要原则是利用放射性核素示踪剂对炎症进行分子成像，包括检测代谢活性、趋化性、细胞募集和脂蛋白富集。其他研究则聚焦于细胞凋亡、血管生成或蛋白水解的可视化。斑块易损性的一个核心特征是其血栓形成性。因此，检测血栓形成斑块是分子成像的另一个有前景的原则。如果能够建立并引入一种可靠的对易破裂易损斑块进行成像的方案并应用于临床实践，就可以采取诸如抗动脉粥样硬化药物治疗或血管重建等必要措施来预防严重心血管事件。
