von Zur Muhlen C, Bode C
Constantin von zur Mühlen, MD, University Heart Center Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany, Tel.+49/(0)761/27 03-78 35; Fax -38 84, E-mail:
Hamostaseologie. 2015;35(3):252-62. doi: 10.5482/HAMO-14-11-0061. Epub 2015 Jan 30.
Atherosclerosis and its sequelae have a major impact on morbidity and mortality. The rupture of an inflamed atherosclerotic plaque is a crucial event, since it can result in acute thrombotic closure of an arterial vessel, resulting e. g. in myocardial infarction or stroke. Not only detection of early plaque rupture with imminent closure is therefore of clinical interest, but also timely detection of vascular inflammation and atherosclerotic plaque progression. However, plaque inflammation or even plaque rupture without vessel occlusion is not reliably detectable by current imaging techniques. Coronary angiography is the gold standard for evaluation of the coronary vessels, but only allows visualization of the vessel lumen without characterizing the important pathophysiology of the vessel wall. Therefore, highly inflamed and rupture prone plaques can be missed, or appear as a minor vessel narrowing. Although currently available techniques such as intravascular ultrasound or optical coherence tomography allow a further characterization of atherosclerotic plaques, it would be desirable to detect plaque inflammation, early plaque rupture or vascular thrombosis by non-invasive techniques such as magnetic resonance imaging (MRI), since they could allow early identification of patients at risk or triage of symptomatic patients. In this manuscript, different strategies for detection of vascular inflammation, plaque-rupture and thrombosis by MRI will be discussed, with a special focus on molecular imaging contrast agents.
动脉粥样硬化及其后遗症对发病率和死亡率有重大影响。炎症性动脉粥样硬化斑块的破裂是一个关键事件，因为它可导致动脉血管急性血栓性闭塞，例如引发心肌梗死或中风。因此，不仅检测即将发生闭塞的早期斑块破裂具有临床意义，及时检测血管炎症和动脉粥样硬化斑块进展也很重要。然而，目前的成像技术无法可靠地检测到斑块炎症，甚至无法检测到无血管闭塞的斑块破裂。冠状动脉造影是评估冠状动脉的金标准，但它仅能显示血管腔，无法描述血管壁的重要病理生理学特征。因此，高度炎症化且易破裂的斑块可能会被漏诊，或表现为轻微的血管狭窄。尽管目前可用的技术，如血管内超声或光学相干断层扫描，能够进一步对动脉粥样硬化斑块进行特征描述，但通过磁共振成像（MRI）等非侵入性技术检测斑块炎症、早期斑块破裂或血管血栓形成将更具优势，因为这些技术能够早期识别高危患者或对有症状的患者进行分类。在本手稿中，将讨论通过MRI检测血管炎症、斑块破裂和血栓形成的不同策略，特别关注分子成像造影剂。
