颈动脉粥样硬化斑块PET-MRI技术的研究进展

Research progress of PET/MR imaging of carotid atherosclerotic plaque

颈动脉粥样硬化是全世界公认的导致缺血性卒中和短暂性脑缺血发作的重要因素。在过去,许多临床试验常常以测量颈动脉狭窄的程度来进行风险分层的一种手段。随着血管成像技术的进步,现在不仅可以根据颈动脉狭窄的程度,还可以根据斑块破裂的脆弱程度,来对患者发生脑血管意外事件风险进行分层。人们意识到斑块的稳定性和易损性比狭窄程度更重要。因为动脉粥样硬化疾病是由动态生物过程(炎症是关键组成部分)驱动的,所以将斑块生物学与斑块结构相结合进行成像可能会提供重要的见解。颈动脉正电子发射断层显像-磁共振成像(positron emission tomography/magnetic resonance imaging,PET-MRI)无侵入性,不仅可以识别高危斑块,而且还可以测量及检测斑块负担及活动性。作者综述了不同示踪剂对动脉粥样硬化斑块进行PET-MRI的作用,包括这种成像方式的原理、当前的限制以及未来的应用。

Carotid atherosclerosis is recognized worldwide as an important factor leading to ischemic stroke and transient ischemic attack.In the past,many clinical trials used to measure the degree of carotid artery stenosis as a means of risk stratification.With the advancement of vascular imaging technology,it is now possible to stratify the risk of cerebrovascular accidents in patients not only according to the degree of carotid artery stenosis,but also according to the fragility of plaque rupture.People realize that the stability and vulnerability of the plaque are more important than the degree of stenosis.Because atherosclerotic diseases are driven by dynamic biological processes(inflammation is a key component),imaging plaque biology and plaque structure may provide important insights.Carotid PET/MR imaging is non-invasive.It can not only identify high-risk plaques,but also measure and detect plaque burden and activity.This review reviews the role of different tracers for state-of-the-art PET/MR imaging of atherosclerotic plaques,including the principles of this imaging method,current limitations,and future applications.