MRI in the early identification and classification of high-risk atherosclerotic carotid plaques.
MRI in the early identification and classification of high-risk atherosclerotic carotid plaques.
复制标题
DOI：
10.2217/iim.09.33
复制
发表时间：
2010-02-01
期刊：
影响因子：
--
通讯作者：
Yuan C
中科院分区：
文献类型：
--
作者：
Hatsukami TS;Yuan C
中风是死亡和长期发病的主要原因。作为预防中风的一种手段，2006年在美国估计进行了99，000例颈动脉内膜切除术。传统上，管腔狭窄的程度已被用作动脉粥样硬化阶段的标志物，并作为外科干预的指征。然而，前瞻性临床试验表明，大多数有近期短暂性脑缺血发作或卒中病史的患者有轻度至中度颈动脉狭窄。使用狭窄标准，这些有症状的个体中的许多人将被认为具有早期颈动脉粥样硬化。很明显，需要改进的标准来识别一系列狭窄中的高风险颈动脉斑块。组织学研究提出了这样的假设：具有较大的富含脂质的坏死核心、薄纤维帽破裂、斑块内出血、斑块新生血管系统和血管壁炎症的斑块是高危“脆弱斑块”的特征。尽管对这些斑块特征的重要性达成了广泛共识，但由于缺乏可靠的成像工具进行体内斑块表征，因此在前瞻性临床研究中测试易损斑块假说受到阻碍。MRI已被证明可以准确识别关键的颈动脉斑块特征，包括纤维帽、富脂坏死核心、斑块内出血、新生血管和血管壁炎症。因此，MRI是一种经过组织学验证的技术，可以对易损斑块假说进行前瞻性检验。本文将总结颈动脉MRI的组织学验证，并强调其在前瞻性临床研究中的应用，旨在早期识别高危动脉粥样硬化颈动脉斑块。
Stroke is a leading cause of mortality and long-term morbidity. As a means for stroke prevention, an estimated 99,000 carotid endarterectomy procedures were performed in the USA in 2006. Traditionally, the degree of luminal stenosis has been used as a marker of the stage of atherosclerosis and as an indication for surgical intervention. However, prospective clinical trials have shown that the majority of patients with a history of recent transient ischemic attack or stroke have mild-to-moderate carotid stenosis. Using stenosis criteria, many of these symptomatic individuals would be considered to have early-stage carotid atherosclerosis. It is evident that improved criteria are needed for identifying the high-risk carotid plaque across a range of stenoses. Histological studies have led to the hypothesis that plaques with larger lipid-rich necrotic cores, thin fibrous cap rupture, intraplaque hemorrhage, plaque neovasculature and vessel wall inflammation are characteristics of the high-risk, ‘vulnerable plaque’. Despite the widespread consensus on the importance of these plaque features, testing the vulnerable plaque hypothesis in prospective clinical studies has been hindered by the lack of reliable imaging tools for in vivo plaque characterization. MRI has been shown to accurately identify key carotid plaque features, including the fibrous cap, lipid-rich necrotic core, intraplaque hemorrhage, neovasculature and vascular wall inflammation. Thus, MRI is a histologically validated technique that will permit prospective testing of the vulnerable plaque hypothesis. This article will provide a summary of the histological validation of carotid MRI, and highlight its application in prospective clinical studies aimed at early identification of the high-risk atherosclerotic carotid plaque.