无创影像学 ACS 应用进展 Non-invasive Imaging on Acute Coronary Syndrome
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无创影像学 ACS 应用进展Non-invasive Imaging on Acute Coronary Syndrome
中国医学科学院北京协和医学院阜外心血管病医院放射科吕滨 2012.05.19
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背景 ACS
急性冠脉综合征( ACS)
不稳定型心绞痛 (UAP)
急性非 ST抬高性心肌梗死( NSTEMI)
急性 ST抬高性心肌梗死(STEMI)
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背景 易损斑块
易损斑块特征: 脂核> 40%斑块体积 血管正性重构 斑块内出血 新生血管、炎症 巨噬细胞浸润的薄纤维帽( 65µm ) 小钙化灶( spotted calcium )
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2011ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation
背景 ACS 指南
诊断? 治疗? 预后?
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ACS 影像学检查
有创冠脉造影血管内超声 IVUS光学相干断层成像 OCT血管内 MRI血管内光谱血管内温度
无创CT
磁共振( MRI )核医学超声心动图
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CT—— 斑块组织成分
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CT—— 斑块体积的测量
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CT—— 易损斑块特征
Motoyama S, Kondo T, Sarai M, Sugiura A, Harigaya H, Sato T, et al. Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes. J Am Coll Cardiol 2007; 50: 319 – 326
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CT—— 易损斑块特性
MDCTand OCT:Case With Ring-Like Enhancement
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动态负荷心肌灌注 -CT新技术 Flash CT 以 75 ms 时间分辨率和动态 8 cm 探测器新特
性
原理:时间-密度曲线,血流量( BF),灌注图
研究进展:动物实验,与 PET 及 SPECT相关性良好
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量化指标 心肌灌注量( myocardial blood flow , MBF) 心肌血流量( myocardial blood volume , MBV) 达峰时间( Time to peak , TTP) 组织通过时间( Tissue transit time , TTT) 血管到组织渗透率( Ktrans )
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解剖与功能“一站式”评价
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CT —— 预测事件
CTA 正常的 NPV 值均为 100%
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CT—— 预测事件
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MRI——ACS 诊断
Sensitivity and specificity of various parameters for ACS.
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MRI -全面评估心肌
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MRI—— 心肌、斑块、血栓、炎症
Grigorios.Et al. Noninvasive Detection of Macrophage-Rich Atherosclerotic Plaque inHyperlipidemic Rabbits Using “Positive Contrast” Magnetic Resonance Imaging.JACC.2008.6(52)483-91
高分辨 MRI
♠ 斑块形态及成分
体外动物实验分子 MRI
♠ 斑块血栓形成
♠ 斑块内脂核
♠ 斑块炎症、斑块新生血管
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MRI—— 心肌受损、心功能预测预后
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SPECT/PET— 血管炎症
Vascular Inflammation Imaging by Studying the Uptake of 18F-Galacto-RGD Into Atherosclerotic Lesions ofHypercholesterolemic Mice
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SPECT/PET——MPI 、 MBF
Myocardial perfusion imaging based on PET with F-18
M. Schwaiger, SNM highlights lecture: cardiovascular
disease. J Nucl Med, 51 Suppl 2 (2010), pp. 15N–19N.
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SPECT/PET——MPI 、 MBF
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超声 - 心肌造影
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超声 - 斑块内新生血管
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无创影像学检查
联合多种影像学技术 , 如 PET-CT 、 PET-MRI ,分子影像学技术
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