Staub Daniel, Partovi Sasan, Imfeld Stephan, Uthoff Heiko, Baldi Thomas, Aschwanden Markus, Jaeger Kurt
Department of Angiology, University Hospital Basel, Switzerland.
Vasa. 2013 Jan;42(1):17-31. doi: 10.1024/0301-1526/a000244.
The use of contrast-enhanced ultrasound (CEUS) for vascular imaging indications has increased dramatically during the last decade. Ultrasound contrast agents are gas-filled microbubbles that are injected into the bloodstream and serve as strict intravascular reflectors of ultrasound waves. Numerous studies have addressed the potential clinical use of CEUS in different vascular fields including the carotid arteries, the abdominal aorta, renal arteries and the kidneys. In this review article we discuss the clinical value of contrast agents in vascular ultrasound by enhancing the vascular lumen, and more important, their role as a tool to deliver high resolution, real-time images of microvascular perfusion. Specifically, CEUS imaging of the carotid artery provides a novel, non-invasive method not only to improve the delineation of the vessel wall, but also for the assessment of the vasa vasorum and the ectopic vascularization of the atherosclerotic plaque (intraplaque neovascularization); probably providing a "window" to risk stratify atherosclerotic lesions and individuals by identifying "vulnerable" plaques prone to rupture causing vascular events. CEUS imaging has also emerged as a novel diagnostic tool in various aortic pathologies and particularly for the detection of endoleaks following endovascular treatment of abdominal aortic aneurysms. It is also a valuable tool for the assessment of the tissue perfusion in native and transplanted kidneys providing information on perfusion deficits of the parenchyma. Furthermore, a real-time CEUS method has recently been developed to assess the skeletal muscle microcirculation which could be used to study patients with peripheral arterial occlusive disease or diabetic microangiopathy. In the future, the use of targeted microbubbles could further enhance and expand the diagnostic capabilities of current vascular ultrasound imaging by detecting specific molecular processes that play a role in the pathophysiology of vascular disease.
在过去十年中，超声造影（CEUS）在血管成像领域的应用显著增加。超声造影剂是注入血流的充气微泡，可作为超声波严格的血管内反射体。众多研究探讨了CEUS在不同血管领域的潜在临床应用，包括颈动脉、腹主动脉、肾动脉和肾脏。在这篇综述文章中，我们讨论了造影剂在血管超声中的临床价值，它可增强血管腔显影，更重要的是，其作为一种工具可提供高分辨率的微血管灌注实时图像。具体而言，颈动脉的CEUS成像提供了一种新颖的非侵入性方法，不仅可改善血管壁的显示，还可用于评估滋养血管以及动脉粥样硬化斑块的异位血管形成（斑块内新生血管形成）；通过识别易于破裂导致血管事件的“易损”斑块，可能为动脉粥样硬化病变和个体的风险分层提供一个“窗口”。CEUS成像在各种主动脉病变中也已成为一种新颖的诊断工具，尤其用于检测腹主动脉瘤血管内治疗后的内漏。它也是评估天然肾和移植肾组织灌注的有价值工具，可提供有关实质灌注不足的信息。此外，最近开发了一种实时CEUS方法来评估骨骼肌微循环，可用于研究外周动脉闭塞性疾病或糖尿病微血管病变患者。未来，靶向微泡的应用可能通过检测在血管疾病病理生理学中起作用的特定分子过程，进一步增强和扩展当前血管超声成像的诊断能力。
