Contrast-enhanced ultrasound imaging of intraplaque neovascularization in carotid arteries
Contrast-enhanced ultrasound imaging of intraplaque neovascularization in carotid arteries
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DOI：
10.1016/j.jacc.2008.02.082
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发表时间：
2008-07-15
影响因子：
24
通讯作者：
Maseri, Attilio
中科院分区：
文献类型：
--
作者：
Coli, Stefano;Magnoni, Marco;Maseri, Attilio
目的评价超声造影在颈动脉粥样硬化斑块内新生血管研究中的应用价值。因此，在本发明中，颈动脉粥样硬化中新生血管的成像可能是临床危险分层和监测抗动脉粥样硬化治疗效果的有用工具。通过标准超声成像和对比增强超声成像研究了两名具有52个颈动脉斑块的患者。在17例接受动脉内膜切除术的患者中，手术标本可通过CD 31/CD 34双染色进行微血管密度的组织学测定。在标准超声成像中评价每个病变的斑块回声和狭窄程度。斑块内的对比剂增强被分类为不存在/外周（1级）和广泛/内部（2级）。结果在手术亚组中，对比剂增强程度较高的斑块在组织学上显示出更多的新血管形成（2级对比1级造影剂增强：中位血管密度：分别为3.24/mm（2）对比1.82/mm（2），p = 0.005）。在全部52个病灶中，回声斑块显示出更高程度的造影剂增强（p < 0.001）。狭窄程度与组织学上的新生血管形成或造影剂增强等级无关。结论颈动脉斑块超声造影剂增强与新生血管的组织学密度相关，并与斑块回声透明相关，这是一种公认的高危病变标记，但与狭窄程度无关。对比增强颈动脉超声成像可以提供有价值的信息斑块危险分层和评估抗动脉粥样硬化治疗的反应，超出了标准超声成像提供的。
Objectives This study was designed to evaluate contrast-enhanced ultrasound imaging of carotid atherosclerosis as a clinical tool to study intraplaque neovascularization.Background Plaque neovascularization is associated with plaque vulnerability and symptomatic disease; therefore, imaging of neovascularization in carotid atherosclerosis may represent a useful tool for clinical risk stratification and monitoring the efficacy of antiatherosclerotic therapies.Methods Thirty-two patients with 52 carotid plaques were studied by standard and contrast-enhanced ultrasound imaging. In 17 of these patients who underwent endarterectomy, the surgical specimen was available for histological determination of microvessel density by CD31/CD34 double staining. Plaque echogenicity and degree of stenosis at standard ultrasound imaging were evaluated for each lesion. Contrast-agent enhancement within the plaque was categorized as absent/peripheral (grade 1) and extensive/internal (grade 2).Results In the surgical subgroup, plaques with higher contrast-agent enhancement showed a greater neovascularization at histology (grade 2 vs. grade 1 contrast-agent enhancement: median vasa vasorum density: 3.24/mm(2) vs. 1.82/mm(2), respectively, p = 0.005). In the whole series of 52 lesions, echolucent plaques showed a higher degree of contrast-agent enhancement (p < 0.001). Stenosis degree was not associated with neovascularization at histology or with the grade of contrast-agent enhancement.Conclusions Carotid plaque contrast-agent enhancement with sonographic agents correlates with histological density of neovessels and is associated with plaque echolucency, a well-accepted marker of high risk lesions, but it is unrelated to the degree of stenosis. Contrast-enhanced carotid ultrasound imaging may provide valuable information for plaque risk stratification and for assessing the response to antiatherosclerotic therapies, beyond that provided by standard ultrasound imaging.