| Objective: In our country, cardiovascular and cerebrovascular diseases are the main cause of death . In recent years, the morbidity and mortality of cardiovascular disease is rasing rapidly, and coronary atherosclerotic heart disease has become a severe threat to public health disease. Acute coronary syndrome are the main factors that cause death of patients with coronary artery disease. Lots of studies have shown that the main mechanism of adverse cardiac events is vulnerable plaque rupture, thrombosis and secondary vasospasm. Although sometimes vulnerable plaque did not cause significant narrow, it is the pathological base of acute coronary events. Therefore, the stability of coronary artery plaque is more important than the degree of luminal stenosis in the process of occurrence , development and outcome of coronary atherosclerotic heart disease. Early identification of vulnerable plaque contributes to the risk stratification of coronary heart disease and select the appropriate treatment measures to stabilize the plaque and improve the prognosis of patients. This paper reviews the diagnostic value and the applied limits of a variety of image methods focusing on the coronary atherosclerotic plaque. Methods: The pertinent literatures were explored from databases on line. Overviewed, the recent more persuasion and correlation literatures were selected to analyse. And then the data of investigation about development of imaging to explore the coronary atherosclerotic plaque was reviewed.Result: Now the imaging methods focusing on plaque is divided into two categories: one category is non-invasive detective methods, such as Multi-slice Spiral Computed Tomography (MSCT), Electron Beam Computed Tomography (EBCT), Positron Emission Computed Tomography (PET), and Magnetic Resonance Imaging ( MRI), etc; the other is invasive detective methods, such as Intravascular Ultrasound (IVUS), Intravascular Ultrasound Elastography (IVUSP) and Intravascular Ultrasound Touch Imaging, Optical Coherence Tomography (OCT), Raman Speetroscopy (RS), Coronary Angioscopy (CAS) and so on.CAG as the gold standard can observe the degree of luminal stenosis, but it can not evaluate the wall and the stability of plaque; And now IVUS is considered as the "gold standard" of diagnosis of coronary atherosclerotic plaque , it helps to early detect the coronary compensatory remodeling , assess the nature of plaque, guide the stent positioning and determine the immediate effect of the treatment ,which makes up for the shortcomings of CAG , but it can not quantitate the plaque composition, because there are a limitation on how to distinguish lipid-rich plaques, necrotic core and thrombosis; MSCT has the ability to evaluate the lumen and plaque, as well as it can make accurate qualitative analysis and quantitative diagnosis of plaque at the same time, its results are consistent with CAG and IVUS, but they are effected by breathing and heart rate easily; MRI has a higher resolution of soft tissue density and spatial resolution, which can distinguish calcification, lipid, fiber and pathological composition of bleeding area in the plaque, which can also quantitate the size, shape and composition of the plaque, it is the most potential method to check the plaque in non-invasive way and to give a comprehensive evaluation. However, assessment of the plaque to use MRI is just preliminary; Nuclear medicine technology has potential advantages in the infiltration of inflammatory cells; RS can not be applied to the recognition of the vulnerable plaque independently, but it can be combined with other technologies; OCT is near to tissue resolution, which can describe the morphological characteristics and nature of the plaque much better, but its most important weaknesses is that it needs to block blood flow temporarily during its operation; CAS can make correct pathological diagnosis to the coronary artery of ACS, which helps to explore the pathogenesis of the disease, and it can predict intra-vascular thrombosis and plaque, and it can evaluate prognosis f disease, but its popularization is limited as the same weaknesses as OCT.Conclusion: A variety of methods of imaging have their own advantages and limitations. As the imaging develops, it is probable to evaluate vulnerable plaque in non-invasive detective methods. It helps to assess the structure and characteristics of composition of coronary plaque, monitor the course of its evolution and identify the vulnerable plaque early, and provide a new basis for the risk stratification as well as the choice of the treatment programs of coronary atherosclerotic heart disease. |
PDF Full Text Request