Potkin B N, Bartorelli A L, Gessert J M, Neville R F, Almagor Y, Roberts W C, Leon M B
Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.
Circulation. 1990 May;81(5):1575-85. doi: 10.1161/01.cir.81.5.1575.
Safe and effective clinical application of new interventional therapies may require more precise imaging of atherosclerotic coronary arteries. To determine the reliability of catheter-based intravascular ultrasound as an imaging modality, a miniaturized prototype ultrasound system (1-mm transducer; center frequency, 25 MHz) was used to acquire two-dimensional, cross-sectional images in 21 human coronary arteries from 13 patients studied at necropsy who had moderate-to-severe atherosclerosis. Fifty-four atherosclerotic sites imagined by ultrasound were compared with formalin-fixed and fresh histological sections of the coronary arteries with a digital video planimetry system. Ultrasound and histological measurements correlated significantly (all p less than 0.0001) for coronary artery cross-sectional area (r = 0.94), residual lumen cross-sectional area (r = 0.85), percent cross-sectional area (r = 0.84), and linear wall thickness (plaque and media) measured at 0 degrees, 90 degrees, 180 degrees, and 270 degrees (r = 0.92). Moreover, ultrasound accurately predicted histological plaque composition in 96% of cases. Anatomic features of the coronary arteries that were easily discernible were the lumen-plaque and media-adventitia interfaces, very bright echoes casting acoustic shadows in calcified plaques, bright and homogeneous echoes in fibrous plaques, and relatively echo-lucent images in lipid-filled lesions. These data indicate that intravascular ultrasound provides accurate image characterization of the artery lumen and wall geometry as well as the presence, distribution, and histological type of atherosclerotic plaque. Thus, ultrasound imaging appears to have great potential application for enhanced diagnosis of coronary atherosclerosis and may serve to guide new catheter-based techniques in the treatment of coronary artery disease.
新的介入治疗方法要实现安全有效的临床应用，可能需要对动脉粥样硬化性冠状动脉进行更精确的成像。为了确定基于导管的血管内超声作为一种成像方式的可靠性，使用了一种小型化原型超声系统（1毫米换能器；中心频率25兆赫），对13例尸检患者的21条人类冠状动脉进行二维横截面成像，这些患者患有中度至重度动脉粥样硬化。通过数字视频平面测量系统，将超声成像的54个动脉粥样硬化部位与冠状动脉的福尔马林固定新鲜组织切片进行比较。超声和组织学测量在冠状动脉横截面积（r = 0.94）、残余管腔横截面积（r = 0.85）、横截面积百分比（r = 0.84）以及在0度、90度、180度和270度测量的线性壁厚度（斑块和中膜）方面具有显著相关性（所有p值均小于0.0001，r = 0.92）。此外，超声在96%的病例中准确预测了组织学斑块成分。冠状动脉易于辨别的解剖特征包括管腔-斑块和中膜-外膜界面、钙化斑块中产生声影的非常明亮的回声、纤维斑块中明亮且均匀的回声以及脂质填充病变中相对无回声的图像。这些数据表明，血管内超声能够准确表征动脉管腔和壁的几何形状以及动脉粥样硬化斑块的存在、分布和组织学类型。因此，超声成像在增强冠状动脉粥样硬化诊断方面似乎具有巨大的潜在应用价值，并且可能有助于指导基于导管的新技术治疗冠状动脉疾病。
