Advances in Multimodality Intravascular Imaging for Identification of High-risk Vulnerable Plaques in Coronary Arteries
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摘要: 冠状动脉粥样硬化斑块破裂或侵蚀引起的血栓形成造成心肌梗死事件的发生。了解斑块是如何从稳定型转变为危及生命的高危易损斑块的过程并寻求有效的早期干预是临床亟需解决的问题。目前，临床中使用的腔内影像学技术可以识别斑块的形态特征，但不能可靠预测哪些稳定型斑块会转变为高危易损斑块发生破裂继发心肌梗死。本文从高危斑块单模态成像进展、血管内分子成像到多模态血管内成像技术的进展作相关整理，并总结近年来多项评估高危易损斑块的研究，对冠脉内高危易损斑块识别的多模态成像在临床转化的可能性和潜力进行综述。Abstract: Coronary thrombosis caused by rupture or erosion of coronary atherosclerotic plaques results in myocardial infarction events. Understanding how plaques change from stable to life-threatening, high-risk vulnerable plaques and seeking effective intervention is a pressing need. Currently, intra-cavitary imaging technology used in clinical practice allows visualization of detailed morphological features of plaques, however, it is not reliable to predict which type of stable plaques will transform into high-risk vulnerable plaques or rupture secondary to myocardial infarction. This article collates advances in single-modality imaging of high-risk plaques, intravascular molecular imaging to the progress of multimodality intravascular imaging, and summarizes studies in recent years to assess high-risk and vulnerable plaques. The possibility and potential of multimodal imaging for plaque identification in clinical transformation are reviewed.
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表 1 易损斑块特征
Table 1. The characteristics of vulnerable plaque
特征 薄纤维帽斑块 影像学手段 形态学特征 钙化 微钙化和钙化结节 CT，OCT IVUS 成骨细胞钙化 18F-氟化钠摄取 钙含量 CT, MRI 管腔细胞 平滑肌细胞迁移 18F-氟乙酰胺摄取 斑块特征 总斑块负荷 CT，MRI 正性重构 IVUS，OCT，光谱学，CT 坏死核心 IVUS，OCT，CT 生物学特征 炎症 巨噬细胞聚集 OCT，光谱学，18F-氟脱氧葡萄糖，18F-氟乙酰胺摄取 血管生成 内皮细胞 18F-氟乙酰胺摄取 VCAM1 放射性标记抗体 新生血管 IVUS，OCT 血流动力学特征 低内皮剪切力 FD-OCT OCT: 血管内光学相干断层扫描; IVUS: 血管内超声. 
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表 2 血管内单模态成像技术特点
Table 2. Characteristics of intravascular single-modality intravascular imaging
声光设备 特点 生物标记成像 IVUS OCT NIRS NIRF FLIM IVPA √ 高分辨率(~10 μm) √ 穿透深度(≥5 mm) 2D脂质成像 √ √ √ 3D脂质成像 √ 炎症 √ 胶原弹力层 √ NIRS: 近红外光谱; NIRF: 近红外荧光分子成像; FLIM: 荧光寿命成像; IVPA: 血管内光声成像.
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