颅内动脉粥样硬化斑块易损性的三维高分辨磁共振研究
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摘要
目的探讨颅内责任斑块与非责任斑块在管壁重构、强化程度方面的差异,确定斑块易损性的影像学标志。资料与方法选取天津医科大学总医院拟行头部加颈部磁共振血管成像检查的疑似动脉粥样硬化患者44例,注入对比剂前后分别加扫3D-T1-SPACE序列。44例患者中,急性脑梗死21例,短暂性脑缺血发作8例,无症状者15例。进一步将斑块分为责任斑块和非责任斑块,比较两种类型斑块在管壁重构模式与强化程度的差异。结果 44例患者发现47枚斑块,其中责任斑块21枚,非责任斑块26枚。5枚责任斑块及7枚非责任斑块所在管壁出现正性重构,两者发生正性重构的比例差异无统计学意义(X~2=0.059,P=0.808);但责任斑块的斑块负荷高于非责任斑块,差异有统计学意义(t=4.59,P<0.001)。所有21枚责任斑块及23枚非责任斑块出现强化,两者出现强化的比例差异无统计学意义(X~2=2.58,P=0.108);但责任斑块的强化程度高于非责任斑块,差异有统计学意义(t=5.04,P<0.001)。结论斑块强化程度可作为斑块易损性的影像学标志。
Purpose To explore the differences in vascular wall remodeling and enhancement degree of intracranial culprit and nonculprit plaque, and to determine the imaging features of plaque vulnerability. Materials and Methods A total of 44 patients with suspected atherosclerosis who underwent magnetic resonance angiography examination of the head and neck were selected from Tianjin Medical University General Hospital. The 3D-T1-SPACE sequence was added before and after the injection of contrast agent. Of the 44 patients, 21 had acute cerebral infarction, 8 transient ischemic attack, and 15 had no symptoms. The plaques were divided into culprit plaque and non-culprit plaque, and the difference between the two types of plaques in terms of vascular wall remodeling pattern and degree of enhancement were compared. Results Forty-seven plaques were found in 44 patients, including 21 culprit plaques and 26 non-culprit plaques. Positive remodeling occurred in the vascular wall of the 5 culprit plaques and 7 non-culprit plaques. There was no statistical significance concerning the difference in the proportion of positive remodeling between the two(X~2=0.059, P=0.808). However, the culprit plaque had higher plaque burden than that of the non-culprit plaque, the difference of which was statistically significant(t=4.59, P<0.001). All 21 culprit plaques and 23 non-culprit plaques were strengthened. There was no statistical significance concerning the difference in the proportion of enhancement between the two groups(X~2=2.58, P=0.108), but the enhancement degree of the culprit plaque was higher than that of the non-culprit plaque, the difference of which was statistically significant(t=5.04, P<0.001). Conclusion The degree of plaque enhancement can be used as an imaging feature for plaque vulnerability.
Purpose To explore the differences in vascular wall remodeling and enhancement degree of intracranial culprit and nonculprit plaque, and to determine the imaging features of plaque vulnerability. Materials and Methods A total of 44 patients with suspected atherosclerosis who underwent magnetic resonance angiography examination of the head and neck were selected from Tianjin Medical University General Hospital. The 3D-T1-SPACE sequence was added before and after the injection of contrast agent. Of the 44 patients, 21 had acute cerebral infarction, 8 transient ischemic attack, and 15 had no symptoms. The plaques were divided into culprit plaque and non-culprit plaque, and the difference between the two types of plaques in terms of vascular wall remodeling pattern and degree of enhancement were compared. Results Forty-seven plaques were found in 44 patients, including 21 culprit plaques and 26 non-culprit plaques. Positive remodeling occurred in the vascular wall of the 5 culprit plaques and 7 non-culprit plaques. There was no statistical significance concerning the difference in the proportion of positive remodeling between the two(X~2=0.059, P=0.808). However, the culprit plaque had higher plaque burden than that of the non-culprit plaque, the difference of which was statistically significant(t=4.59, P<0.001). All 21 culprit plaques and 23 non-culprit plaques were strengthened. There was no statistical significance concerning the difference in the proportion of enhancement between the two groups(X~2=2.58, P=0.108), but the enhancement degree of the culprit plaque was higher than that of the non-culprit plaque, the difference of which was statistically significant(t=5.04, P<0.001). Conclusion The degree of plaque enhancement can be used as an imaging feature for plaque vulnerability.
引文
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[17]Schmid M,Pflederer T,Jang IK,et al.Relationship between degree of remodeling and CT attenuation of plaque in coronary atherosclerotic lesions:an in-vivo analysis by multi-detector computed tomography.Atherosclerosis,2008,197(1):457-464.
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[20]Xu WH,Li ML,Gao S,et al.In vivo high-resolution MRimaging of symptomatic and asymptomatic middle cerebral artery atherosclerotic stenosis.Atherosclerosis,2010,212(2):507-511.
[21]Lam WM,Wong KS,So NC,et al.Plaque volume measurement by magnetic resonance imaging as an index of remodeling of middle cerebral artery:correlation with transcranial color doppler and magnetic resonance angiography.Cerebrovasc Dis,2004,17(2/3):166-169.
[22]Shi MC,Wang SC,Zhou HW,et al.Compensatory remodeling in symptomatic middle cerebral artery atherosclerotic stenosis:a high-resolution MRI and microemboli monitoring study.Neurol Res,2012,34(2):153-158.
[23]Swartz RH,Bhuta SS,Farb RI,et al.Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI.Neurology,2009,72(7):627-634.
[24]Qiao Y,Zeiler SR,Mirbagheri S,et al.Intracranial plaque enhancement in patients with cerebrovascular events on highspatial-resolution MR images.Radiology,2014,271(2):534-542.
[25]Vergouwen MD,Silver FL,Mandell DM,et al.Eccentric narrowing and enhancement of symptomatic middle cerebral artery stenoses in patients with recent ischemic stroke.Arch Neurol,2011,68(3):338-342.
[26]Klein IF,Lavallée PC,Mazighi M,et al.Basilar artery atherosclerotic plaques in paramedian and lacunar pontine infarctions.Stroke,2010,41(7):1405-1409.
[27]Klein IF,Lavallée PC,Touboul PJ,et al.In vivo middle cerebral artery plaque imaging by high-resolution MRI.Neurology,2006,67(2):327-329.
[28]Kerwin WS,Oikawa M,Yuan C,et al.MR imaging of adventitial vasa vasorum in carotid atherosclerosis.Magn Reson Med,2008,59(3):507-514.
[29]Aoki S,Aoki K,Ohsawa S,et al.Dynamic MR imaging of the carotid wall.J Magn Reson Imaging,1999,9(3):420-427.
[30]Aydin Faruk Do human intracranial arteries lack vasa vasorum?A comparative immunohistochemical study of intracranial and systemic arteries.Acta Neuropathologica,1998,96(1):22-28.
[31]Connolly ES,Huang J,Goldman JE,et al.Immunohistochemical detection of intracranial vasa vasorum:a human autopsy study.Neurosurgery,1996,38(4):789-793.
[32]Atkinson JD,Haruo O,Sundt JM,et al.Intracranial cerebrovascular vasa vasorum associated with atherosclerosis and large thick-walled aneurysms.Surg Neurol,1991,36(5):365-369.
[33]Kathryn M,Taylor W.Robert the role of the adventitia in vascular inflammation.Cardiovasc Res,2007,75(4):640-648.
[34]Ritman EL.Lermana the dynamic vasa vasorum.Cardiovasc Res,2007,75(4):649-658.
[35]De Boer OJ,Van Der Wal AC,Teeling P,et al.Leucocyte recruitment in rupture prone regions of lipid-rich plaques:a prominent role for neovascularization?Cardiovasc Res,1999,41(2):443-449.
[2]Millon A,Boussel L,Brevet M,et al.Clinical and histological significance of gadolinium enhancement in carotid atherosclerotic plaque.Stroke,2012,43(11):3023-3028.
[3]Magnani G,Demola MA,Fava C,et al.From vulnerable plaque to vulnerable patient.G Ital Cardiol(Rome),2010,11(12 Suppl 3):6S-9S.
[4]韩旭,赵锡海,崔豹,等.颈动脉粥样硬化疾病评分与高分辨率磁共振成像特征关系研究.中华老年心脑血管病杂志,2018,(2):117-121.
[5]李春玲,蔺田芳.高分辨率磁共振成像技术对大脑中动脉粥样硬化斑块的评价分析.医学影像学杂志,2018,24(2):203-206.
[6]Gorelick PB,Wong KS,Bae HJ,et al.Large artery intracranial occlusive disease:a large worldwide burden but a relatively neglected frontier.Stroke,2008,39(8):2396-2399.
[7]Wong KS,Huang YN,Gao S,et al.Intracranial stenosis in Chinese patients with acute stroke.Neurology,1998,50(3):812-813.
[8]Caplan LR,Gorelick PB,Hier DB.Race,sex and occlusive cerebrovascular disease:a review.Stroke,1986,17(4):648.
[9]Tatu L,Moulin T,Vuillier F,et al.Arterial territories of the human brain.Front Neurol Neurosci,2012,30(6):99-110.
[10]Skarpathiotakis M,Mandell DM,Swartz RH,et al.Intracranial atherosclerotic plaque enhancement in patients with ischemic stroke.Am J Neuroradiol,2013,34(2):299-304.
[11]Vakil P,Vranic J,Hurley MC,et al.T1 gadolinium enhancement of intracranial atherosclerotic plaques associated with symptomatic ischemic presentations.Am JNeuroradiol,2013,34(12):2252-2258.
[12]Qiao Y,Etesami M,Astor BC,et al.Carotid plaque neovascularization and hemorrhage detected by MR imaging are associated with recent cerebrovascular ischemic events.Am J Neuroradiol,2012,33(4):755-760.
[13]Pasterkamp G,Schoneveld AH,Van Wolferen W,et al.The impact of atherosclerotic arterial remodeling on percentage of luminal stenosis varies widely within the arterial system.A postmortem study.Arterioscler Thromb Vasc Biol,1997,17(11):3057-3063.
[14]Qiao Y,Steinman DA,Qin Q,et al.Intracranial arterial wall imaging using three-dimensional high isotropic resolution black blood MRI at 3.0 Tesla.J Magn Reson Imaging,2011,34(1):22-30.
[15]Takeuchi H,Morino Y,Matsukage T,et al.Impact of vascular remodeling on the coronary plaque compositions:an investigation with in vivo tissue characterization using integrated backscatter-intravascular ultrasound.Atherosclerosis,2009,202(2):476-482.
[16]Kume T,Okura H,Kawamoto T,et al.Relationship between coronary remodeling and plaque characterization in patients without clinical evidence of coronary artery disease.Atherosclerosis,2008,197(2):799-805.
[17]Schmid M,Pflederer T,Jang IK,et al.Relationship between degree of remodeling and CT attenuation of plaque in coronary atherosclerotic lesions:an in-vivo analysis by multi-detector computed tomography.Atherosclerosis,2008,197(1):457-464.
[18]Burke AP,Kolodgie FD,Farb A,et al.Morphological predictors of arterial remodeling in coronary atherosclerosis.Circulation,2002,105(3):297-303.
[19]Chung GH,Kwak HS,Hwang SB,et al.High resolution MRimaging in patients with symptomatic middle cerebral artery stenosis.Eur J Radiol,2012,81(12):4069-4074.
[20]Xu WH,Li ML,Gao S,et al.In vivo high-resolution MRimaging of symptomatic and asymptomatic middle cerebral artery atherosclerotic stenosis.Atherosclerosis,2010,212(2):507-511.
[21]Lam WM,Wong KS,So NC,et al.Plaque volume measurement by magnetic resonance imaging as an index of remodeling of middle cerebral artery:correlation with transcranial color doppler and magnetic resonance angiography.Cerebrovasc Dis,2004,17(2/3):166-169.
[22]Shi MC,Wang SC,Zhou HW,et al.Compensatory remodeling in symptomatic middle cerebral artery atherosclerotic stenosis:a high-resolution MRI and microemboli monitoring study.Neurol Res,2012,34(2):153-158.
[23]Swartz RH,Bhuta SS,Farb RI,et al.Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI.Neurology,2009,72(7):627-634.
[24]Qiao Y,Zeiler SR,Mirbagheri S,et al.Intracranial plaque enhancement in patients with cerebrovascular events on highspatial-resolution MR images.Radiology,2014,271(2):534-542.
[25]Vergouwen MD,Silver FL,Mandell DM,et al.Eccentric narrowing and enhancement of symptomatic middle cerebral artery stenoses in patients with recent ischemic stroke.Arch Neurol,2011,68(3):338-342.
[26]Klein IF,Lavallée PC,Mazighi M,et al.Basilar artery atherosclerotic plaques in paramedian and lacunar pontine infarctions.Stroke,2010,41(7):1405-1409.
[27]Klein IF,Lavallée PC,Touboul PJ,et al.In vivo middle cerebral artery plaque imaging by high-resolution MRI.Neurology,2006,67(2):327-329.
[28]Kerwin WS,Oikawa M,Yuan C,et al.MR imaging of adventitial vasa vasorum in carotid atherosclerosis.Magn Reson Med,2008,59(3):507-514.
[29]Aoki S,Aoki K,Ohsawa S,et al.Dynamic MR imaging of the carotid wall.J Magn Reson Imaging,1999,9(3):420-427.
[30]Aydin Faruk Do human intracranial arteries lack vasa vasorum?A comparative immunohistochemical study of intracranial and systemic arteries.Acta Neuropathologica,1998,96(1):22-28.
[31]Connolly ES,Huang J,Goldman JE,et al.Immunohistochemical detection of intracranial vasa vasorum:a human autopsy study.Neurosurgery,1996,38(4):789-793.
[32]Atkinson JD,Haruo O,Sundt JM,et al.Intracranial cerebrovascular vasa vasorum associated with atherosclerosis and large thick-walled aneurysms.Surg Neurol,1991,36(5):365-369.
[33]Kathryn M,Taylor W.Robert the role of the adventitia in vascular inflammation.Cardiovasc Res,2007,75(4):640-648.
[34]Ritman EL.Lermana the dynamic vasa vasorum.Cardiovasc Res,2007,75(4):649-658.
[35]De Boer OJ,Van Der Wal AC,Teeling P,et al.Leucocyte recruitment in rupture prone regions of lipid-rich plaques:a prominent role for neovascularization?Cardiovasc Res,1999,41(2):443-449.