Jansen Krista, van Soest Gijs, van der Steen Antonius F W
Department of Biomedical Engineering, Thorax Centre, Erasmus University Medical Center, Rotterdam, The Netherlands; Interuniversity Cardiology Institute of The Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands.
Department of Biomedical Engineering, Thorax Centre, Erasmus University Medical Center, Rotterdam, The Netherlands.
Ultrasound Med Biol. 2014 Jun;40(6):1037-48. doi: 10.1016/j.ultrasmedbio.2014.01.008. Epub 2014 Mar 14.
The vulnerable atherosclerotic plaque is believed to be at the root of the majority of acute coronary events. Even though the exact origins of plaque vulnerability remain elusive, the thin-cap fibroatheroma, characterized by a lipid-rich necrotic core covered by a thin fibrous cap, is considered to be the most prominent type of vulnerable plaque. No clinically available imaging technique can characterize atherosclerotic lesions to the extent needed to determine plaque vulnerability prognostically. Intravascular photoacoustic imaging (IVPA) has the potential to take a significant step in that direction by imaging both plaque structure and composition. IVPA is a natural extension of intravascular ultrasound that adds tissue type specificity to the images. IVPA utilizes the optical contrast provided by the differences in the absorption spectra of plaque components to image composition. Its capability to image lipids in human coronary atherosclerosis has been shown extensively ex vivo and has recently been translated to an in vivo animal model. Other disease markers that have been successfully targeted are calcium and inflammatory markers, such as macrophages and matrix metalloproteinase; the latter two through application of exogenous contrast agents. By simultaneously displaying plaque morphology and composition, IVPA can provide a powerful prognostic marker for disease progression, and as such has the potential to transform the current practice in percutaneous coronary intervention.
易损性动脉粥样硬化斑块被认为是大多数急性冠状动脉事件的根源。尽管斑块易损性的确切起源仍不清楚，但以富含脂质的坏死核心被薄纤维帽覆盖为特征的薄帽纤维粥样瘤被认为是最典型的易损斑块类型。目前临床上尚无可用的成像技术能够在预测斑块易损性所需的程度上对动脉粥样硬化病变进行特征描述。血管内光声成像（IVPA）有潜力通过对斑块结构和成分进行成像在这方面迈出重要一步。IVPA是血管内超声的自然延伸，它为图像增添了组织类型特异性。IVPA利用斑块成分吸收光谱差异提供的光学对比度来成像成分。其对人类冠状动脉粥样硬化中脂质成像的能力已在大量体外研究中得到证实，并且最近已转化到体内动物模型中。其他已成功靶向的疾病标志物是钙和炎症标志物，如巨噬细胞和基质金属蛋白酶；通过应用外源性造影剂对后两者进行成像。通过同时显示斑块形态和成分，IVPA可为疾病进展提供强大的预后标志物，因此有潜力改变目前经皮冠状动脉介入治疗的实践。
