基于人工智能的冠状动脉易损斑块腔内影像学研究进展

Research progress of intravascular imaging of vulnerable coronary plaque based on artificial intelligence

斑块的不稳定导致冠状动脉的血栓性闭塞是大多数急性冠脉综合征(ACS)的原因。尽管罪犯血管得以及时开通,但非罪犯血管的易损斑块对患者远期预后仍存在较大威胁。因此,动态评估易损斑块的变化,对冠心病患者格外重要。冠状动脉血管腔内成像技术,如血管内超声(IVUS)、光学相干断层扫描(OCT)、近红外光谱(NIRS)以及其多模态融合技术等,因其可视化、准确度高,可以揭示易损斑块的不同特征,常用于检测易损斑块。而IVUS、OCT等图像解释需有经验的心血管临床医生逐帧判断,需要大量的时间成本,且图像的解读存在的观察者内及观察者间的差异,这推动了人工智能(AI)在冠状动脉血管腔内影像学应用的发展。由于电子医疗系统的广泛应用、临床大数据的日益暴增,AI已在医疗行业获得了极大的进展。人工智能结合腔内影像学在斑块的识别、干预、预后等诸多方面广泛应用,未来将不断优化诊疗系统,提高精准医疗水平,实现对易损斑块的早期诊断及合理干预。

Plaque vulnerability leading to thrombotic occlusion of coronary arteries is the main cause of majori-ty of acute coronary syndrome(ACS).Despite the criminal vessels can be opened in time,the vulnerable plaques of non-criminal vessels still cause a great threat to the long-term prognosis of patients.Thus,dynamic assessment of vulner-able plaque changes is particularly important for patients with coronary heart disease.Intravascular imaging techniques in coronary arteries,such as intravascular ultrasound(IVUS),Optical Coherence Tomography(OCT),Near Infrared Spectrum Instrument(NIRS),and its multi-mode fusion technology,are often used to detect vulnerable plaques due to their high visualization and accuracy,which can reveal different characteristics of vulnerable plaques.However,IVUS,OCT and other image interpretation requires experienced cardiovascular clinicians to judge frame by frame,which re-quires a large amount of time cost,and there are intra-observer and inter-observer differences in image interpretation,which all promotes the development of AI in the application of intravascular coronary imaging.Artificial intelligence(AI)has made great progress in the medical field due to the wide application of electronic medical information system and the increasing explosion of clinical big data.Artificial intelligence combined with intravascular imaging has been widely ap-plied in the identification,intervention,prognosis,and many other aspects of plaque,which,in the future,will promote the diagnosis and treatment model,improve the level of precision medicine,and realize the early diagnosis and reasonable in-tervention of vulnerable plaques.