多模态成像无创评价颈动脉斑块易损性:从形态显像到精准诊断
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摘要
斑块的性质是继狭窄之外各类影像学检查关注的焦点,也代表更为普遍的动脉粥样硬化表型。斑块易损性或易损斑指斑块具有易破裂并诱发血栓形成的特性,从而导致不同心脑血管事件。其在影像学上表现为斑块溃疡,斑块内出血,薄或破裂的纤维帽,脂质丰富的坏死核,钙化以及炎症反应、新生血管形成,多个形态学特性互相影响、互为因果、复合加权决定斑块的易损性。目前的影像学方法尽管可以提供从斑块形态到炎性代谢乃至机械形变的各类信息,但仅凭一种检查手段尚无法可靠评价斑块易损性并预估中风风险。通过多模态成像从不同角度显示斑块特征,有助于全面、客观评价斑块构成和生物学特性,达到对斑块易损性的精准评估。
Characters of carotid plaque have been the focus of inspections in imaging modalities besides stenosis, which also indicate the common phenotype of atherosclerosis. The term"vulnerable plaque"is used to refer to an atherosclerotic plaque that is prone to rupture and the formation of thrombosis, which can lead to several cardiovascular and cerebrovascular events.Features of vulnerable plaque include surface ulceration, intraplaque hemorrhage, a thin fibrous cap, a large lipid necrotic core,calcification, inflammation and neovascularization. They interact with each other and plaque vulnerability depends on joints effects. Although plaque information of morphology, metabolism and biology can be shown by imaging modalities, currently there is no single imaging modality that can reliably identify the vulnerable plaque in relation to development of future stroke.Therefore, multimodality imaging was an effect way to observe features of plaque from different angles, which contributes to an integral, objective evaluation of plaque components and make a precision diagnosis of vulnerable plaque.
Characters of carotid plaque have been the focus of inspections in imaging modalities besides stenosis, which also indicate the common phenotype of atherosclerosis. The term"vulnerable plaque"is used to refer to an atherosclerotic plaque that is prone to rupture and the formation of thrombosis, which can lead to several cardiovascular and cerebrovascular events.Features of vulnerable plaque include surface ulceration, intraplaque hemorrhage, a thin fibrous cap, a large lipid necrotic core,calcification, inflammation and neovascularization. They interact with each other and plaque vulnerability depends on joints effects. Although plaque information of morphology, metabolism and biology can be shown by imaging modalities, currently there is no single imaging modality that can reliably identify the vulnerable plaque in relation to development of future stroke.Therefore, multimodality imaging was an effect way to observe features of plaque from different angles, which contributes to an integral, objective evaluation of plaque components and make a precision diagnosis of vulnerable plaque.
引文
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[2]Qureshi AI,Alexandrov AV,Tegeler CH,et al.Guidelines for screening of extracranial carotid artery disease:a statement for healthcare professionals from the multidisciplinary practice guidelines committee of the American Society of Neuroimaging;cosponsored by the Society of Vascular and Interventional Neurology[J].J Neuroimaging,2007,17(1):19-47.
[3]Cires-Drouet RS,Mozafarian M,Ali A,et al.Imaging of high-risk carotid plaques:ultrasound[J].Semin Vasc Surg,2017,30(1):44-53.
[4]Saba L,Anzidei M,Marincola BC,et al.Imaging of the carotid artery vulnerable plaque[J].Cardiovasc Intervent Radiol,2014,37(3):572-585.
[5]Rafailidis V,Chryssogonidis I,Tegos T,et al.Imaging of the ulcerated carotid atherosclerotic plaque:a review of the literature[J].Insights Imaging,2017,8(2):213-225.
[6]Papaioannou TG,Kalantzis C,Katsianos E,et al.Personalized assessment of the coronary atherosclerotic arteries by intravascular ultrasound imaging:Hunting the vulnerable plaque[J].J Pers Med,2019,9(1):8.
[7]Taishi Y,Ik-Kyung J.Advances in intravascular imaging:New insights into the vulnerable plaque from imaging studies[J].Korean Circ J,2018,48(1):1-15.
[8]Finn AV,Nakano M,Narula J,et al.Concept of vulnerable/unstable plaque[J].Arterioscler Thromb Vasc Biol,2010,30(7):1282-1292.
[9]Marnane M,Prendeville S,McDonnell C,et al.Plaque inflammation and unstable morphology are associated with early stroke recurrence in symptomatic carotid stenosis[J].Stroke,2014,45(3):801-806.
[10]余海歌,何文,张东,等.多模态超声评价颈动脉斑块易损性的多因素分析[J].中国卒中杂志,2018,13(9):922-927.
[11]Hjelmgren O,Johansson L,Prahl U,et al.Inverse association between size of the lipid-rich necrotic core and vascularization in human carotid plaques[J].Clin Physiol Funct Imaging,2018,38(2):326-331.
[12]Vicenzini E,Giannoni MF,Puccinelli F,et al.Detection of carotid adventitial vasa vasorum and plaque vascularization with ultrasound cadence contrast pulse sequencing technique and echo-contrast agent[J].Stroke,2007,38(10):2841-2843.
[13]Saba L,Caddeo G,Sanfilippo R,et al.CT and ultrasound in the study of ulcerated carotid plaque compared with surgical results:potentialities and advantages of multidetector row CTangiography[J].AJNR Am J Neuroradiol,2007,28(6):1061-1066.
[14]Underhill HR,Yuan C,Yarnykh VL,et al.Predictors of surface disruption with MR imaging in asymptomatic carotid artery stenosis[J].AJNR Am J Neuroradiol,2010,31(3):487-493.
[15]JM UK-I,Fox AJ,Aviv RI,et al.Characterization of carotid plaque hemorrhage:a CT angiography and MR intraplaque hemorrhage study[J].Stroke,2010,41(8):1623-1629.
[16]Bailey G,Meadows J,Morrison AR.Imaging Atherosclerotic Plaque Calcification:Translating Biology[J].Curr Atheroscler Rep,2016,18(8):51.
[17]Huibers A,de Borst GJ,Wan S,et al.Non-invasive Carotid Artery Imaging to Identify the Vulnerable Plaque:Current Status and Future Goals[J].Eur J Vasc Endovasc Surg,2015,50(5):563-572.
[18]Saba L,Anzidei M,Sanfilippo R,et al.Imaging of the carotid artery[J].Atherosclerosis,2012,220(2):294-309.
[19]Muraki M,Mikami T,Yoshimoto T,et al.New criteria for the sonographic diagnosis of a plaque ulcer in the extracranial carotid artery[J].AJR Am J Roentgenol,2012,198(5):1161-1166.
[20]Arning C,Eckert B.The diagnostic relevance of colour Doppler artefacts in carotid artery examinations[J].Eur J Radiol,2004,51(3):246-251.
[21]Saha SA,Gourineni V,Feinstein SB.The Use of Contrastenhanced Ultrasonography for Imaging of Carotid Atherosclerotic Plaques:Current Evidence,Future Directions[J].Neuroimaging Clin N Am,2016,26(1):81-96.
[22]ten Kate GL,van Dijk AC,van den Oord SC,et al.Usefulness of contrast-enhanced ultrasound for detection of carotid plaque ulceration in patients with symptomatic carotid atherosclerosis[J].Am J Cardiol,2013,112(2):292-298.
[23]Kuk M,Wannarong T,Beletsky V,et al.Volume of carotid artery ulceration as a predictor of cardiovascular events[J].Stroke,2014,45(5):1437-1441.
[24]Madani A,Beletsky V,Tamayo A,et al.High-risk asymptomatic carotid stenosis:ulceration on 3D ultrasound vs TCDmicroemboli[J].Neurology,2011,77(8):744-750.
[25]Vucaj-Cirilovic V,Lucic M,Petrovic K,et al.Color Doppler ultrasonography and multislice computer tomography angiography in carotid plaque detection and characterization[J].Vojnosanit Pregl,2011,68(5):423-429.
[26]Etesami M,Hoi Y,Steinman D A,et al.Comparison of carotid plaque ulcer detection using contrast-enhanced and time-of-flight MRA techniques[J].AJNR Am JNeuroradiol,2013,34(1):177-184.
[27]Brinjikji W,Huston J,Rabinstein AA,et al.Contemporary carotid imaging:from degree of stenosis to plaque vulnerability[J].JNeurosurg,2016,124(1):27-42.
[28]Yu W,Underhill HR,Ferguson MS,et al.The added value of longitudinal black-blood cardiovascular magnetic resonance angiography in the cross sectional identification of carotid atherosclerotic ulceration[J].J Cardiovasc Magn Reson,2009,11:31.
[29]Anzidei M,Napoli A,Zaccagna F,et al.Diagnostic accuracy of colour Doppler ultrasonography,CT angiography and bloodpool-enhanced MR angiography in assessing carotid stenosis:a comparative study with DSA in 170 patients[J].Radiol Med,2012,117(1):54-71.
[30]Anzidei M,Napoli A,Geiger D,et al.Preliminary experience with MRA in evaluating the degree of carotid stenosis and plaque morphology using high-resolution sequences after gadofosveset trisodium(Vasovist)administration:comparison with CTA and DSA[J].Radiol Med,2010,115(4):634-647.
[31]Virmani R,Kolodgie FD,Burke AP,et al.Atherosclerotic plaque progression and vulnerability to rupture:angiogenesis as a source of intraplaque hemorrhage[J].Arterioscler Thromb Vasc Biol,2005,25(10):2054-2061.
[32]Walker LJ,Ismail A,McMeekin W,et al.Computed tomography angiography for the evaluation of carotid atherosclerotic plaque:correlation with histopathology of endarterectomy specimens[J].Stroke,2002,33(4):977-981.
[33]Saba L,Mallarini G.Fissured fibrous cap of vulnerable carotid plaques and symptomaticity:are they correlated?Preliminary results by using multi-detector-row CT angiography[J].Cerebrovasc Dis,2009,27(4):322-327.
[34]Ajduk M,Pavic L,Bulimbasic S,et al.Multidetector-row computed tomography in evaluation of atherosclerotic carotid plaques complicated with intraplaque hemorrhage[J].Ann Vasc Surg,2009,23(2):186-193.
[35]Ajduk M,Bulim basic S,Pavic L,et al.Comparison of multidetector-row computed tomography and duplex Doppler ultrasonography in detecting atherosclerotic carotid plaques complicated with intraplaque hemorrhage[J].Coll Antropol,2013,37(1):213-219.
[36]den Hartog AG,Bovens SM,Koning W,et al.Current status of clinical magnetic resonance imaging for plaque characterisation in patients with carotid artery stenosis[J].Eur J Vasc Endovasc Surg,2013,45(1):7-21.
[37]Sztajzel R,Momjian S,Momjian-Mayor I,et al.Stratified grayscale median analysis and color mapping of the carotid plaque:correlation with endarterectomy specimen histology of 28patients[J].Stroke,2005,36(4):741-745.
[38]Wintermark M,Jawadi SS,Rapp JH,et al.High-resolution CTimaging of carotid artery atherosclerotic plaques[J].AJNR Am JNeuroradiol,2008,29(5):875-882.
[39]Wahlgren CM,Zheng W,Shaalan W,et al.Human carotid plaque calcification and vulnerability.Relationship between degree of plaque calcification,fibrous cap inflammatory gene expression and symptomatology[J].Cerebrovasc Dis,2009,27(2):193-200.
[40]Sakamoto A,Virmani R,Finn AV.Coronary artery calcification:recent developments in our understanding of its pathologic and clinical significance[J].Curr Opin Cardiol,2018,33(6):645-652.
[41]Ma T,Zhou B,Hsiai TK,et al.A Review of Intravascular Ultrasound-based Multimodal Intravascular Imaging:The Synergistic Approach to Characterizing Vulnerable Plaques[J].Ultrason Imaging,2016,38(5):314-331.
[42]Vengrenyuk Y,Carlier S,Xanthos S,et al.A hypothesis for vulnerable plaque rupture due to stress-induced debonding around cellular microcalcifications in thin fibrous caps[J].Proc Natl Acad Sci USA,2006,103(40):14678-14683.
[43]Virmani R,Burke AP,Farb A,et al.Pathology of the vulnerable plaque[J].J Am Coll Cardiol,2006,47(8 Sl):C13-18.
[44]Puri R,Nicholls SJ,Shao M,et al.Impact of statins on serial coronary calcification during atheroma progression and regression[J].J Am Coll Cardiol,2015,65(13):1273-1282.
[45]Criqui MH,Denenberg JO,Ix JH,et al.Calcium density of coronary artery plaque and risk of incident cardiovascular events[J].Jama,2014,311(3):271-278.
[46]Yang J,Pan XJ,Zhang B,et al.Superficial and multiple calcifications and ulceration associate with intraplaque hemorrhage in the carotid atherosclerotic plaque[J].Eur Radiol,2018,28(12):4968-4977.
[47]Paprottka KJ,Saam D,Rubenthaler J,et al.Prevalence and distribution of calcified nodules in carotid arteries in correlation with clinical symptoms[J].Radiol Med,2017,122(6):449-457.
[48]Miralles M,Merino J,Busto M,et al.Quantification and characterization of carotid calcium with multi-detector CT-angiography[J].Eur J Vasc Endovasc Surg,2006,32(5):561-567.
[49]Kelly-Arnold A,Maldonado N,Laudier D,et al.Revised microcalcification hypothesis for fibrous cap rupture in human coronaryar teries[J].Proc Natl Acad Sci USA,2013,110(26):10741-10746.
[50]Pereira T,Betriu A,Alves R.Non-invasive imaging techniques and assessment of carotid vasa vasorum neovascularization:Promises and pitfalls[J].Trends Cardiovasc Med,2019,29(2):71-80.
[51]Joshi F R,Lind say A C,Obaid D R,et al.Non-invasive imaging of atherosclerosis[J].Eur Heart J Cardiovasc Imaging,2012,13(3):205-218.
[52]Owen DR,Shalhoub J,Miller S,et al.Inflammation within carotid atherosclerotic plaque:assessment with late-phase contrastenhanced US[J].Radiology,2010,255(2):638-644.
[53]Alonso A,Artemis D,Hennerici MG.Molecular imaging of carotid plaque vulnerability[J].Cerebrovasc Dis,2015,39(1):5-12.
[54]Thapar A,Shalhoub J,Averkiou M,et al.Dose-dependent artifact in the far wall of the carotid artery at dynamic contrastenhanced US[J].Radiology,2012,262(2):672-679.
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