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动脉粥样硬化是一种动脉壁慢性炎症性疾病,其特征是在大、中型动脉管壁内形成斑块。颈动脉粥样硬化斑块是导致缺血性脑卒中的主要原因之一,其潜在病理机制包括易损斑块破裂后的血管栓塞,或斑块破裂后血栓的形成和扩散导致的急性血管闭塞[1]。有研究结果表明,易损斑块的破裂与斑块内出血、薄或破裂的纤维帽伴斑块溃疡、富含脂质的坏死核心以及钙化密切相关[2]。最近的一项研究结果显示,基线时斑块内出血的存在增加了同侧脑卒中的风险,有斑块内出血与无斑块内出血患者的同侧脑卒中年事件发生率分别为9.0%与0.7%(颈动脉狭窄<50%)、18.1%与2.1%(颈动脉狭窄50%~69%)、29.3 %与1.5%(颈动脉狭窄70%~99%)[3]。因此,简单可靠地评估易损斑块的斑块内出血和斑块内新生血管,进一步筛选出即将发生脑血管事件或脑血管事件风险较高的患者,可以尽早进行临床干预,预防脑血管事件的发生。我们将重点综述不同成像模式(包括超声、CT、MR和核医学)下的斑块内出血和斑块内新生血管的特征。
颈动脉粥样硬化斑块内血管化和出血的影像学研究进展
Imaging research progress of intraplaque vascularization and hemorrhage in carotid atherosclerotic plaques
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摘要: 斑块内出血是动脉粥样硬化斑块不稳定的主要因素之一,斑块内出血的诊断对于颈动脉斑块患者的正确分期、治疗以及预防缺血性脑卒中至关重要。组织病理学检查是评价斑块内出血的“金标准”,但需要通过颈动脉内膜切除术来收集组织样本。然而,影像检查可作为一种非侵入性的方法来检测斑块内出血。笔者就颈动脉粥样硬化斑块内血管化和斑块内出血在超声、CT、MRI和核医学等方面的主要特点和发展前景进行综述。Abstract: Intraplaque hemorrhage is one of the main factors involved in atherosclerotic plaque instability. The diagnosis of intraplaque hemorrhage is very important for the correct staging, treatment and prevention of ischemic stroke in patients with carotid plaque. Histopathological examination is the "gold standard" to evaluate intraplaque haemorrhage, but it required carotid endarterectomy surgery to collect the tissue sample. Therefore, imaging examination can be used as a non-invasive method to detect intraplaque haemorrhage. This paper reviews the main characteristics and development prospects of intraplaque vascularization and intraplaque haemorrhage in ultrasound, computed tomography, magnetic resonance and nuclear medicine.
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