Andelovic Kristina, Winter Patrick, Jakob Peter Michael, Bauer Wolfgang Rudolf, Herold Volker, Zernecke Alma
Institute of Experimental Biomedicine, University Hospital Würzburg, 97080 Würzburg, Germany.
Experimental Physics V, University of Würzburg, 97074 Würzburg, Germany.
Biomedicines. 2021 Feb 12;9(2):185. doi: 10.3390/biomedicines9020185.
Atherosclerosis is an inflammatory disease of large and medium-sized arteries, characterized by the growth of atherosclerotic lesions (plaques). These plaques often develop at inner curvatures of arteries, branchpoints, and bifurcations, where the endothelial wall shear stress is low and oscillatory. In conjunction with other processes such as lipid deposition, biomechanical factors lead to local vascular inflammation and plaque growth. There is also evidence that low and oscillatory shear stress contribute to arterial remodeling, entailing a loss in arterial elasticity and, therefore, an increased pulse-wave velocity. Although altered shear stress profiles, elasticity and inflammation are closely intertwined and critical for plaque growth, preclinical and clinical investigations for atherosclerosis mostly focus on the investigation of one of these parameters only due to the experimental limitations. However, cardiovascular magnetic resonance imaging (MRI) has been demonstrated to be a potent tool which can be used to provide insights into a large range of biological parameters in one experimental session. It enables the evaluation of the dynamic process of atherosclerotic lesion formation without the need for harmful radiation. Flow-sensitive MRI provides the assessment of hemodynamic parameters such as wall shear stress and pulse wave velocity which may replace invasive and radiation-based techniques for imaging of the vascular function and the characterization of early plaque development. In combination with inflammation imaging, the analyses and correlations of these parameters could not only significantly advance basic preclinical investigations of atherosclerotic lesion formation and progression, but also the diagnostic clinical evaluation for early identification of high-risk plaques, which are prone to rupture. In this review, we summarize the key applications of magnetic resonance imaging for the evaluation of plaque characteristics through flow sensitive and morphological measurements. The simultaneous measurements of functional and structural parameters will further preclinical research on atherosclerosis and has the potential to fundamentally improve the detection of inflammation and vulnerable plaques in patients.
动脉粥样硬化是一种发生在大中型动脉的炎症性疾病，其特征是动脉粥样硬化病变（斑块）的生长。这些斑块通常在动脉的内曲率、分支点和分叉处形成，这些部位的内皮壁剪切应力较低且呈振荡性。与脂质沉积等其他过程一起，生物力学因素会导致局部血管炎症和斑块生长。也有证据表明，低剪切应力和振荡剪切应力会导致动脉重塑，从而导致动脉弹性丧失，进而使脉搏波速度增加。尽管剪切应力分布改变、弹性和炎症密切相关且对斑块生长至关重要，但由于实验限制，动脉粥样硬化的临床前和临床研究大多仅关注这些参数中的一个。然而，心血管磁共振成像（MRI）已被证明是一种强大的工具，可用于在一次实验中深入了解一系列生物学参数。它能够评估动脉粥样硬化病变形成的动态过程，而无需有害辐射。流动敏感MRI可评估血流动力学参数，如壁剪切应力和脉搏波速度，这可能会取代基于侵入性和辐射的技术来成像血管功能和表征早期斑块发展。结合炎症成像，对这些参数的分析和相关性不仅可以显著推进动脉粥样硬化病变形成和进展的基础临床前研究，还可以推进对易破裂的高危斑块进行早期识别的诊断性临床评估。在本综述中，我们总结了磁共振成像通过流动敏感和形态学测量评估斑块特征的关键应用。同时测量功能和结构参数将进一步推动动脉粥样硬化的临床前研究，并有可能从根本上改善对患者炎症和易损斑块的检测。
