Prospects for multimodality imaging in peripheral artery disease.
Prospects for multimodality imaging in peripheral artery disease.
复制标题
外周动脉疾病多模态成像的前景。
DOI：
10.1161/circimaging.113.001434
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Kinlay,Scott
中科院分区：
文献类型：
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作者：
Kinlay,Scott
核CT对血管血流的联合评估，主要与小动脉的动脉形成有关，在哪里最有可能获得支持？显而易见的答案是在临床试验中评估促进动脉生成的疗法，例如基于细胞的疗法。4、5目前针对严重肢体缺血患者的临床试验正确地聚焦于治疗对肢体丧失和创面愈合的影响。鉴于许多基于细胞的治疗都失败了，一种帮助量化体内动脉形成的技术可能有助于从那些应该被放弃的治疗中识别需要进一步研究的治疗。目前的研究描述了猪模型中的核CT技术。下一步应该是在活人身上评估这项技术，以测试其在临床实践和研究中的价值。这将包括将这项技术与目前公认的行走功能和血流的症状和生理测试进行比较。其他研究应该评估这项技术在更典型的人类条件下的疾病谱上的重复性。动脉形成对于没有血运重建选择的严重肢体缺血患者是非常重要的。在这些患者中，使用这种多模式技术评估血流和解剖变化的关系似乎是合乎逻辑的，以促进伤口愈合和预防截肢。如果它能确定有临床意义的动脉生成，这项技术可能会为更大的临床试验确定新的基于细胞的治疗方法。对于临床实践来说，与目前的工具相比，这项技术的增量价值将需要数据表明，这种方法可以以可接受的成本导致临床管理的变化-在我们对卫生资源的需求更大的时代，这一门槛变得越来越重要。
Where would a combined nuclear CT assessment of blood vessel flow, predominantly related to arteriogenesis of small arteries, most likely gain traction? The obvious answer is in clinical trials to assess therapies promoting arteriogenesis, for example, cell-based therapies. 4, 5 Current clinical trials in patients with critical limb ischemia focus correctly on the effect of treatment on limb loss and wound healing. Given the failure of many cell-based therapies, a technique that helps quantify arteriogenesis in vivo could help identify therapies that require further study from those that should be abandoned.The current study describes the technique of nuclear CT in a porcine model. The next stage should be to evaluate the technique in living humans to test its value for both clinical practice and research. This would include comparisons of this technique with current well-accepted symptomatic and physiological tests of walking function and blood flow. Other studies should assess the reproducibility of the technique across the spectrum of diseases more typical of the human condition. Arteriogenesis is highly valued in patients with critical limb ischemia without revascularization options. In these patients, it seems logical to assess the relationship of blood flow and anatomic changes using this multimodality technique to wound healing and prevention of amputation. If it can identify clinically meaningful arteriogenesis, the technique may identify novel cell-based therapies for larger clinical trials. For clinical practice, the incremental value of this technique compared with current tools will require data showing that this method can lead to changes in clinical management at an acceptable cost—a bar that is increasingly important in our era of greater demands on health resources.