颈动脉易损斑块影像学评估的现在与未来

Imaging Evaluation of Vulnerable Carotid Plaques:Present Status and Future Prospect

颈动脉粥样硬化性狭窄是缺血性卒中的公认危险因素,占卒中或短暂性缺血发作的10%~20%。常规的脑血管检查技术只能显示管腔的狭窄程度,而不能阐明狭窄的结构和狭窄的原因。因此,仅在脑血管疾病的诊断中研究管腔狭窄的程度,对评估疾病的特征和预防卒中的危险分层显然是不够的。对斑块和动脉壁基于成像特征如斑块内出血(IPH)、溃疡、新生血管、纤维帽(FC)厚度和富含脂质的坏死核心(LRNC)等的无创评估是指导治疗的基本方法。本综述总结了当前在颈动脉易损斑块成像中,血管壁成像包括磁共振成像(MRI)、计算机断层扫描(CT)和超声(US)诊断方法的更新。

Carotid atherosclerotic stenosis is a well-established risk factor of ischemic stroke,contributing to up to 10%-20% of strokes or transient ischemic attacks.Routine cerebrovascular examination techniques can only show the degree of stenosis of the lumen,but cannot demonstrate the structure of the stenosis and the cause of the stenosis.Therefore,simply studying the degree of luminal stenosis in the diagnosis of cerebrovascular disease,is obviously insufficient to assess the characteristics of the disease and stratify the risk for preventing stroke.Non-invasive in vivo assessment of plaques and arterial walls based on the presence of imaging features such as intraplaque hemorrhage,ulceration,neovascularity,fibrous cap thickness,and lipid-rich necrotic core is a basic method to guide treatment.This review summarizes recent updates on vessel wall imaging modalities for the evaluation of carotid vulnerable plaques,such as MRI,CT and ultrasound.