Imaging advances in the diagnosis of plaque erosion in patients with acute coronary syndromes
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摘要: 斑块侵蚀是急性冠脉综合征的重要发病机制之一。针对斑块侵蚀的急性冠脉综合征患者，抗栓治疗而非支架治疗是其更为安全有效的治疗选择，因此临床上斑块侵蚀的准确识别至关重要。技术的发展极大地推进了斑块侵蚀的诊断进展，本文从人体尸检研究的重要发现、光学相干断层扫描、血管内超声、近红外光谱、冠状动脉计算机断层扫描血管造影、生物标志物几个方面展开，就上述诊断手段进行回顾与总结。Abstract: Plaque erosion is one of the important pathogenesis of acute coronary syndrome. For patients with acute coronary syndrome with plaque erosion, antithrombotic therapy rather than stent implantation is a safer and more effective treatment option, so the accurate clinical identification of plaque erosion in clinic is quite critical. The development of technology has greatly advanced the diagnosis of plaque erosion. This article reviews and summarizes the diagnostic methods from the human autopsy studies, optical coherence tomography, intravascular ultrasound, near-infrared spectroscopy, coronary computed tomography angiography, and biomarkers.
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表 1 不同诊断手段的特点对比
Table 1. Comparison of the characteristics of different diagnostic methods
诊断手段 优点 缺点 OCT 分辨率高(10~15 μm)，直接准确识别斑块类型；对斑块微观结构提供更多信息，包括纤维帽、微血管、血栓、炎症细胞和胆固醇结晶等[6, 19] 基于导管的侵入式成像方式；无法显示内皮细胞的损伤；易受叠加血栓影响[19, 23] IVUS 较OCT更为简易；对斑块分布和形态进行纵向和横截面的实时评估[25]; 识别易损斑块和高风险个体；指导个体化介入治疗选择 基于导管的侵入式成像方式低分辨率（100~200 μm），无法准确识别薄纤维帽（< 65 μm）[6, 26] NIRS 检测脂质成分，量化脂质积累；通过评估冠状动脉钙化点、斑块空腔和maxLCBI4mm判别斑块类型；具有预测ACS患者预后的价值[35, 37] 基于导管的侵入式成像方式; 需要结合IVUS使用，量化复杂 CCTA 无创操作；以非侵入性方式对所有主要冠脉及其分支的斑块负荷进行全局评估[40]；识别高风险个体；方便重复呈现以观察斑块进展或预测斑块预后 低分辨率（0.5 mm），无法直接识别纤维帽和脂质核心[39-40] OCT: 光学相干断层扫描; IVUS: 血管内超声; NIRS: 近红外光谱; CCTA: 冠状动脉计算机断层扫描血管造影. 
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