Circulation. 2017 Aug 29;136(9):787-797. doi: 10.1161/CIRCULATIONAHA.117.028433. Epub 2017 Jul 18.
Ultrasmall superparamagnetic particles of iron oxide (USPIO) detect cellular inflammation on magnetic resonance imaging (MRI). In patients with abdominal aortic aneurysm, we assessed whether USPIO-enhanced MRI can predict aneurysm growth rates and clinical outcomes.
In a prospective multicenter open-label cohort study, 342 patients with abdominal aortic aneurysm (diameter ≥40 mm) were classified by the presence of USPIO enhancement and were monitored with serial ultrasound and clinical follow-up for ≥2 years. The primary end point was the composite of aneurysm rupture or repair.
Participants (85% male, 73.1±7.2 years) had a baseline aneurysm diameter of 49.6±7.7 mm, and USPIO enhancement was identified in 146 (42.7%) participants, absent in 191 (55.8%), and indeterminant in 5 (1.5%). During follow-up (1005±280 days), 17 (5.0%) abdominal aortic aneurysm ruptures, 126 (36.8%) abdominal aortic aneurysm repairs, and 48 (14.0%) deaths occurred. Compared with those without uptake, patients with USPIO enhancement have increased rates of aneurysm expansion (3.1±2.5 versus 2.5±2.4 mm/year, =0.0424), although this was not independent of current smoking habit (=0.1993). Patients with USPIO enhancement had higher rates of aneurysm rupture or repair (47.3% versus 35.6%; 95% confidence intervals, 1.1-22.2; =0.0308). This finding was similar for each component of rupture (6.8% versus 3.7%, =0.1857) or repair (41.8% versus 32.5%, =0.0782). USPIO enhancement was associated with reduced event-free survival for aneurysm rupture or repair (=0.0275), all-cause mortality (=0.0635), and aneurysm-related mortality (=0.0590). Baseline abdominal aortic aneurysm diameter (<0.0001) and current smoking habit (=0.0446) also predicted the primary outcome, and the addition of USPIO enhancement to the multivariate model did not improve event prediction (c-statistic, 0.7935-0.7936).
USPIO-enhanced MRI is a novel approach to the identification of aortic wall cellular inflammation in patients with abdominal aortic aneurysms and predicts the rate of aneurysm growth and clinical outcome. However, it does not provide independent prediction of aneurysm expansion or clinical outcomes in a model incorporating known clinical risk factors.
URL: http://www.isrctn.com. Unique identifier: ISRCTN76413758.
超小超顺磁性氧化铁（USPIO）可在磁共振成像（MRI）上检测细胞炎症。在腹主动脉瘤患者中，我们评估了USPIO增强MRI是否能够预测动脉瘤的生长速率和临床结局。
在一项前瞻性多中心开放标签队列研究中，342例腹主动脉瘤（直径≥40mm）患者根据是否存在USPIO增强进行分类，并通过连续超声和临床随访监测≥2年。主要终点是动脉瘤破裂或修复的复合情况。
参与者（85%为男性，年龄73.1±7.2岁）的基线动脉瘤直径为49.6±7.7mm，146例（42.7%）参与者存在USPIO增强，191例（55.8%）不存在，5例（1.5%）不确定。在随访期间（1005±280天），发生了17例（5.0%）腹主动脉瘤破裂、126例（36.8%）腹主动脉瘤修复和48例（14.0%）死亡。与未摄取者相比，存在USPIO增强的患者动脉瘤扩张速率增加（3.1±2.5对2.5±2.4mm/年，P=0.0424），尽管这与当前吸烟习惯无关（P=0.1993）。存在USPIO增强的患者动脉瘤破裂或修复率更高（47.3%对35.6%；95%置信区间，1.1 - 22.2；P=0.0308）。对于破裂（6.8%对3.7%，P=0.1857）或修复（41.8%对32.5%，P=0.0782）的各个组成部分，这一发现相似。USPIO增强与动脉瘤破裂或修复的无事件生存期降低相关（P=0.0275）、全因死亡率降低相关（P=0.0635）以及动脉瘤相关死亡率降低相关（P=0.0590）。基线腹主动脉瘤直径（P<0.0001）和当前吸烟习惯（P=0.0446）也可预测主要结局，并且在多变量模型中加入USPIO增强并未改善事件预测（c统计量，0.7935 - 0.7936）。
USPIO增强MRI是一种识别腹主动脉瘤患者主动脉壁细胞炎症的新方法，并可预测动脉瘤的生长速率和临床结局。然而，在纳入已知临床风险因素的模型中，它并不能独立预测动脉瘤扩张或临床结局。
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