Monitoring the biological activity of abdominal aortic aneurysms Beyond Ultrasound.
Monitoring the biological activity of abdominal aortic aneurysms Beyond Ultrasound.
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DOI：
10.1136/heartjnl-2015-308779
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发表时间：
2016-06-01
期刊：
影响因子：
--
通讯作者：
Robson JM
中科院分区：
文献类型：
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作者：
Forsythe RO;Newby DE;Robson JM
腹主动脉瘤(AAA)是发病率的一个重要原因，当破裂时，80%的死亡率与此相关。目前的治疗决策是基于腹部超声对动脉瘤直径的评估。然而，AAA的生长是非线性的，破裂可能发生在小直径或可能永远不会发生在那些AAA较大的患者。有必要开发更好的成像生物标志物，以识别与动脉瘤直径无关的潜在破裂风险。AAA进展和破裂的关键病理生物学过程包括新生血管形成、坏死性炎症、微钙化和细胞外基质的蛋白降解。这些过程是新兴成像技术的关键靶点，在已知的患者相关风险因素之外，可能会增加扩张或破裂的风险。磁共振成像使用超小的超顺磁性氧化铁颗粒，可以识别和跟踪巨噬细胞活动的热点。正电子发射断层扫描使用各种靶向示踪剂，可以检测炎症、血管生成、缺氧和微钙化的区域。这些细胞和分子成像技术超越了使用超声波对直径扩张的简单监测，可能具有改善扩张或破裂预测的潜力，并更好地指导选择性手术干预。
Abdominal aortic aneurysms (AAAs) are an important cause of morbidity and, when ruptured, are associated with >80% mortality. Current management decisions are based on assessment of aneurysm diameter by abdominal ultrasound. However, AAA growth is non-linear and rupture can occur at small diameters or may never occur in those with large AAAs. There is a need to develop better imaging biomarkers that can identify the potential risk of rupture independent of the aneurysm diameter. Key pathobiological processes of AAA progression and rupture include neovascularisation, necrotic inflammation, microcalcification and proteolytic degradation of the extracellular matrix. These processes represent key targets for emerging imaging techniques and may confer an increased risk of expansion or rupture over and above the known patient-related risk factors. Magnetic resonance imaging, using ultrasmall superparamagnetic particles of iron oxide, can identify and track hotspots of macrophage activity. Positron emission tomography, using a variety of targeted tracers, can detect areas of inflammation, angiogenesis, hypoxia and microcalcification. By going beyond the simple monitoring of diameter expansion using ultrasound, these cellular and molecular imaging techniques may have the potential to allow improved prediction of expansion or rupture and to better guide elective surgical intervention.