实验性研究代谢综合征患者的颈动脉粥样硬化斑块的MRI特征
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摘要
第一部分多序列MRI显示正常兔颈动脉
目的:探讨多序列MRI(TOF、T1WI、T2WI、PDWI)技术显示正常兔颈总动脉方法的可行性及准确性。
材料与方法:选择普通级新西兰大白兔20只,麻醉状态下分别对颈总动脉行多重对比序列MRI扫描和数字减影血管造影(DSA),选取相当于兔第三颈椎中间同一层面的图像资料,分别测量MRI和DSA上同一侧,相同层面的颈总动脉的血管直径作相关分析;同时将T1WI、T2WI及TOF原始图像传入工作站,用MIP及MPR方法进行血管重建分析。
结果:MRI及DSA测量血管直径的平均数值分别为2.42±0.15和2.15±0.08mm,两者相关性具有统计学差异。T1WI、T2WI及TOF的MIP及MPR重建图像质量佳,重复性好,可以替代DSA了解血管情况。
结论:多序列对比MRI方法可以准确地及无创地评价兔颈总动脉的直径,血管壁信号,联合应用血管重建技术可以替代DSA来诊断及评价血管粥样硬化疾病。为建立兔颈动脉粥样斑块模型奠定基础,更加有助于探索人类颈动脉粥样硬化疾病的发生,发展以及与缺血性疾病之间的关系。
第二部分实验性颈动脉粥样硬化斑块模型建立和MRI评价
目的:利用新西兰兔建立颈动脉粥样硬化模型,探索颈动脉粥样硬化斑块模型建立的可行性,并通过MR特殊线圈检测斑块,与病理对照观察斑块的MRI表现,为进一步研究颈动脉粥样硬化斑块与脑缺血的关系奠定基础。
材料和方法:利用高脂饮食饲养成年新西兰大白兔20只,饲养前均行颈动脉MRI检查,作为正常对照。8周后,在DSA辅助下经球囊损伤一侧颈动脉内膜,造影观察到内膜毛糙后停止操作。7日后行MRI扫描观察颈动脉管壁信号变化。继续高脂饲养2月后,14、21、35、63、70天行颈动脉MRI检查,最后取病理对照。
结果:20只兔饲养至3周时由于各种原因死亡4只,行球囊拉损术时死亡4只,其余12只均造模成功,成功率为75%(12/16)。第一次MRI显示管壁T1WI,PDWI及T2WI均为高信号,第2-6次MRI检查显示管壁内膜明显增厚,病理显示管壁内膜下局部泡沫细胞明显增多,同时平滑肌细胞积聚,形成类似于人类病变的粥样斑块。
结论:高脂饮食饲养后行颈动脉球囊拉损制作兔颈动脉粥样硬化斑块是切实可行的办法,MRI是良好的检测颈动脉损伤和显示颈动脉斑块的方法。
第三部分颈动脉MRI成像技术:四反转恢复序列应用的对照研究
目的:为了降低血液流动伪影、吞咽等运动伪影,缩短成像时间,提高图像分辨率,本研究主要应用QIR—FSE序列与常规只采用流动预饱和的FSE—T1WI序列进行颈动脉成像的对照研究。
材料与方法:对3名(其中有两名是颈动脉粥样斑块患者)志愿者分别使用两种序列(QIR—FSE T1WI序列与只采用流动预报和方法的T1WI FSE序列)对双侧颈动脉成像,共获得18层图像,对照观察有无流动伪影的产生,根据有无血液流动伪影及吞咽运动伪影,请三名高年资医师分别对图像质量评分,评分标准为:5分—无伪影,4分—单侧流动伪影无运动伪影,3分—双侧流动伪影无运动伪影,2分—单侧流动伪影伴运动伪影,1分—双侧流动伪影伴运动伪影。将评分结果进行配对非参数检验方法进行统计学分析。
结果:QIR—FSE T1WI的平均评分为4.6,只采用流动预报和带的常规FSE平均评分为2.6,P＜0.05,统计学上有显著性差异。QIR-FSE的18层图像中均未发现血液流动伪影,而FSE有90%出现血液流动伪影,尤其位于颈动脉分叉处,容易和粥样斑块混淆。
结论:说明QIR—FSE T1WI成像质量明显高于常规只应用流动预报和的FSE T1WI序列,血液流入信号被很有效地抑制,有利于更好地显示粥样硬化斑块,尤其适合于颈动脉增强MRI的成像研究。
第四部分:代谢综合征患者的颈动脉粥样硬化斑块的特征
目的:为了阐述代谢综合征与颈动脉粥样硬化斑块之间的联系,根据国内外学者的大量研究,代谢综合征尤其是合并高血压的患者更加容易出现颈动脉粥样硬化疾病,所以我们设计了对照性研究,来研究代谢综合征及其组成部分与颈动脉粥样硬化斑块之间的联系。
材料与方法:按照代谢综合征WHO定义,入选了六十个病人,每个病人都接受了头部及颈部的MRI扫描,应用Student's t tests和Fisher's exact test来对照描述性研究有斑块组和无斑块组与代谢综合征的联系。
结果:在这些代谢综合征的患者中,有斑块的病人平均年龄为70.0±9.7岁,无斑块的平均年龄为69.7±7.6岁,P值为0.90,有斑块的所有病人中男性占54.2%,无斑块的病人中男性占58.3%,P值为0.80。有斑块的患者中有41.7%的患者吸烟,无斑块的患者中也有41.7%的病人吸烟,P为1。颈动脉粥样斑块中有75.0%的病人有代谢综合征,而无斑块的病人中患有代谢综合征的患者只有41.7%,P值为0.026。有斑块的患者中有37.5%有家族史,无斑块的患者中有36.7%的患者有家族史,P值为0.79。分析粥样斑块成分时:有46位患者斑块表面有厚而且完整的纤维帽(96%),有2位有薄及破裂的纤维帽(4%)。斑块内有血肿的为1位(2%)。斑块内有钙化的为36位(75%)。分析颈动脉斑块的位置时,我们以颈动脉分叉处为中心上下5厘米的范围之内:斑块多位于颈动脉分叉处43人(90%),位于颈总动脉其次3人(6%),位于颈内动脉2人(4%)。
结论:通过本研究,我们认为有代谢综合征患者更加容易患粥样硬化斑块,而年龄、性别、吸烟史及家族史与代谢综合征无明显联系。在本研究中,合并代谢综合征的颈动脉粥样硬化斑块病人的斑块96%纤维帽是完整的,只有4%是不完整的,56%患者斑块中心有钙化,斑块主要发生于颈动脉分叉处:2%患者斑块内有血肿,需要密切随访及内、外科治疗。所以本研究中代谢综合征患者的颈动脉粥样硬化斑块大部分是稳定的,少数是不稳定的,有待于大样本及前瞻性研究进一步证实。
PartⅠMulti-contrast MRI Imaging Characterize the Carotid artery in Rabbits
Purpose:Our aim was to explore the feasibility and accuracy of multi-contrast MRI imaging((TOF、T1WI、T2WI、PDWI) to show the carotid artery of rabbits.
Material and Methods:20 New Zealand rabbits underwent multi-contrast MRI scan and DSA respectively.The images of the same slice were compared and the diameter of the ipsilateral carotid artery was measured.At the same time,the source images of T1WI,T2WI and TOF were reconstructed by the means of MIP and MPR.
Results:The mean of diameter is 2.42±0.15mm measured by MRI and 2.15±0.08mm by DSA.The two measurements were highly correlated,with a correlation coefficient of 0.749(P＜0.01) The reconstructed imagings is excellent.
Conclusions:Multi-contrast MRI is an noninvasive technology which can evaluate the diameter and characterize the wall signal of carotid artery accurately.Combined with vascular reconstruction technology,the new multi-contrast MRI is going to take the place of DSA to diagnose atherosclerosis.In the conclusion,the new and promising technology will facilitate build an atherosclerotic animal model.And future MRI studies may improve our understanding of the pathophysiology of atherosclerosis and its relationship with cerebral ischemia in human.
PartⅡEstablishing experimental atherosclerosis and evaluated by serial MRI
Purpose:Establishing the experimental carotid atherosclerosis of New Zealand rabbits is to explore the feasibility of this method and evaluated it by phased array coil according to histology,which is helpful to study the relationship between carotid atherosclerosis and cerebral ischemia diseasse.
Material and Methods:After the initiation of a high cholesterol diet for 8 weeks,20 rabbits underwent balioon injury of common carotid artery.The trauma of vascular was examined by MRI seven days later after the surgery.We continued to feed the rabbits with a high cholesterol diet for 2 month and examined the carotid artery by MRI every 2 weeks.At the end of the study,the rabbits were killed by an intravenous overdose of fluanizone and phentany.Tissue samples from each carotid artery were compared with the imagings of the rabbits.
Results:There are three rabbits died in the feeding and four died after balloon injury,ln the summary,achievement ratio of this experimental model is 75%(12/16).We can see high signal density in the wall of trauma vascular in the first MRI(7 days after surgery).In the second to sixth MRI,intimal thickeness can be seen.The accumulation of foam cells results in the formation of fatty streaks,Smooth muscle cells immigrate from the medial layer into the subendothelial space where they may proliferate,ingest modified lipoproteins and contribute to lesion development,which is similar to the lesion in human vessel.
Conclusions:It is feasible to establish experimental atherosclerosis combinating a high cholesterol diet with balloon injury.MRI is a good tool to examine the trauma vessel and carotid atherosclerosis.
PartⅢCarotid MRI technique:Comparative Research of QIR
PURPOSE:In order to eliminate motion and flow artifacts,reduce scan time,and improve spatial resolution,we apply QIR-FSE and FSE only with flow saturation in comparative research.
MATERIALS AND METHODS:There are three patients went through this researsh.We used both QIR-T1WI FSE and TIWI FSE only with flow saturation in each patient.We accquired 18 images in total.Three attending doctors devide these images into five qualities according to having artifacts or not.Five score -no artifact;four score-flow artifact in only one side,but no motion artifact;three artifact - flow artifact in both sides,but no motion artifact,two score-flow artifact and motion artifact in only one side;one score-flow artifact and motion artifact in both sides.We used non-parametric test to analyse results.
RESULTS:The means of QIR—FSE T1WI is 4.6 and FSE T1WI 2.6.P＜0.05.There is significant difference in statistical analysis.
CONCLUSION:In conclusion,the qualitity of image with QIR-FSE T1WI is better than images with T1WI FSE.In-flow signal were eliminate effectively with QIR-FSE T1WI,which make the images more clearer.,especially in enhance MRI scan.
PartⅣCharacteristics of Carotid Plague MRI in Metabolic Syndrome
PURPOSE:To clarify the relationship between metabolic syndrome and carotid atherosclerosis plague,we design a comparative research to test this relationship.
MATERIALS AND METHODS:Sixty patients were chosen in the research according to WHO defination on Metabolic Syndrome.They all took MRI on both carotid artery and head.We apply Student's t tests and Fisher's exact test in analyzing the data.
RESULTS:The mean age of patients with atherosclerosis plague is 70.0±9.7,whereas patients without atherosclerosis plague is 69.7±7.6.There are 54.2%patients with carotid atherosclerosis plague,which are male.There are 58.3%patients without carotid atherosclerosis plague,which are male.There are 41.7%patients smoking with carotid atherosclerosis plague.There are 41.7%patients smoking without carotid atherosclerosis plague.Among the patients with atherosclerosis plague,there are 75.0%patients with metabolic syndrome.Among the patients without atherosclerosis plague,there are 41.7% patients with metabolic syndrome.P=0.026.Among the patients with atherosclerosis plague,there are 37.5%patients having family history.Among the patients without atherosclerosis plague,there are 36.7%patients with metabolic syndrome having family history.There are 46 patients with carotid atherosclerosis plague,which have thick and intact fiber cap. There are 2 patients with carotid atherosclerosis plague,which have thin and rupture fiber cap.There are one patient with carotid atherosclerosis plague,which have haemorrhage in plague.There are 36 patients with carotid atherosclerosis plague,which have calcification in the plague.
CONCLUSION:In this research,patients with metabolic syndrome have the tendency to suffer from carotid atherosclerosis plague.And the characteristic of the plague are stable in most with intact fiber cap and calcification in the center of the plague.Most plague located in the bifurcation of carotid artery.Our conclusion need to be tested in large sample through prospective research in the future.
目的:探讨多序列MRI(TOF、T1WI、T2WI、PDWI)技术显示正常兔颈总动脉方法的可行性及准确性。
材料与方法:选择普通级新西兰大白兔20只,麻醉状态下分别对颈总动脉行多重对比序列MRI扫描和数字减影血管造影(DSA),选取相当于兔第三颈椎中间同一层面的图像资料,分别测量MRI和DSA上同一侧,相同层面的颈总动脉的血管直径作相关分析;同时将T1WI、T2WI及TOF原始图像传入工作站,用MIP及MPR方法进行血管重建分析。
结果:MRI及DSA测量血管直径的平均数值分别为2.42±0.15和2.15±0.08mm,两者相关性具有统计学差异。T1WI、T2WI及TOF的MIP及MPR重建图像质量佳,重复性好,可以替代DSA了解血管情况。
结论:多序列对比MRI方法可以准确地及无创地评价兔颈总动脉的直径,血管壁信号,联合应用血管重建技术可以替代DSA来诊断及评价血管粥样硬化疾病。为建立兔颈动脉粥样斑块模型奠定基础,更加有助于探索人类颈动脉粥样硬化疾病的发生,发展以及与缺血性疾病之间的关系。
第二部分实验性颈动脉粥样硬化斑块模型建立和MRI评价
目的:利用新西兰兔建立颈动脉粥样硬化模型,探索颈动脉粥样硬化斑块模型建立的可行性,并通过MR特殊线圈检测斑块,与病理对照观察斑块的MRI表现,为进一步研究颈动脉粥样硬化斑块与脑缺血的关系奠定基础。
材料和方法:利用高脂饮食饲养成年新西兰大白兔20只,饲养前均行颈动脉MRI检查,作为正常对照。8周后,在DSA辅助下经球囊损伤一侧颈动脉内膜,造影观察到内膜毛糙后停止操作。7日后行MRI扫描观察颈动脉管壁信号变化。继续高脂饲养2月后,14、21、35、63、70天行颈动脉MRI检查,最后取病理对照。
结果:20只兔饲养至3周时由于各种原因死亡4只,行球囊拉损术时死亡4只,其余12只均造模成功,成功率为75%(12/16)。第一次MRI显示管壁T1WI,PDWI及T2WI均为高信号,第2-6次MRI检查显示管壁内膜明显增厚,病理显示管壁内膜下局部泡沫细胞明显增多,同时平滑肌细胞积聚,形成类似于人类病变的粥样斑块。
结论:高脂饮食饲养后行颈动脉球囊拉损制作兔颈动脉粥样硬化斑块是切实可行的办法,MRI是良好的检测颈动脉损伤和显示颈动脉斑块的方法。
第三部分颈动脉MRI成像技术:四反转恢复序列应用的对照研究
目的:为了降低血液流动伪影、吞咽等运动伪影,缩短成像时间,提高图像分辨率,本研究主要应用QIR—FSE序列与常规只采用流动预饱和的FSE—T1WI序列进行颈动脉成像的对照研究。
材料与方法:对3名(其中有两名是颈动脉粥样斑块患者)志愿者分别使用两种序列(QIR—FSE T1WI序列与只采用流动预报和方法的T1WI FSE序列)对双侧颈动脉成像,共获得18层图像,对照观察有无流动伪影的产生,根据有无血液流动伪影及吞咽运动伪影,请三名高年资医师分别对图像质量评分,评分标准为:5分—无伪影,4分—单侧流动伪影无运动伪影,3分—双侧流动伪影无运动伪影,2分—单侧流动伪影伴运动伪影,1分—双侧流动伪影伴运动伪影。将评分结果进行配对非参数检验方法进行统计学分析。
结果:QIR—FSE T1WI的平均评分为4.6,只采用流动预报和带的常规FSE平均评分为2.6,P＜0.05,统计学上有显著性差异。QIR-FSE的18层图像中均未发现血液流动伪影,而FSE有90%出现血液流动伪影,尤其位于颈动脉分叉处,容易和粥样斑块混淆。
结论:说明QIR—FSE T1WI成像质量明显高于常规只应用流动预报和的FSE T1WI序列,血液流入信号被很有效地抑制,有利于更好地显示粥样硬化斑块,尤其适合于颈动脉增强MRI的成像研究。
第四部分:代谢综合征患者的颈动脉粥样硬化斑块的特征
目的:为了阐述代谢综合征与颈动脉粥样硬化斑块之间的联系,根据国内外学者的大量研究,代谢综合征尤其是合并高血压的患者更加容易出现颈动脉粥样硬化疾病,所以我们设计了对照性研究,来研究代谢综合征及其组成部分与颈动脉粥样硬化斑块之间的联系。
材料与方法:按照代谢综合征WHO定义,入选了六十个病人,每个病人都接受了头部及颈部的MRI扫描,应用Student's t tests和Fisher's exact test来对照描述性研究有斑块组和无斑块组与代谢综合征的联系。
结果:在这些代谢综合征的患者中,有斑块的病人平均年龄为70.0±9.7岁,无斑块的平均年龄为69.7±7.6岁,P值为0.90,有斑块的所有病人中男性占54.2%,无斑块的病人中男性占58.3%,P值为0.80。有斑块的患者中有41.7%的患者吸烟,无斑块的患者中也有41.7%的病人吸烟,P为1。颈动脉粥样斑块中有75.0%的病人有代谢综合征,而无斑块的病人中患有代谢综合征的患者只有41.7%,P值为0.026。有斑块的患者中有37.5%有家族史,无斑块的患者中有36.7%的患者有家族史,P值为0.79。分析粥样斑块成分时:有46位患者斑块表面有厚而且完整的纤维帽(96%),有2位有薄及破裂的纤维帽(4%)。斑块内有血肿的为1位(2%)。斑块内有钙化的为36位(75%)。分析颈动脉斑块的位置时,我们以颈动脉分叉处为中心上下5厘米的范围之内:斑块多位于颈动脉分叉处43人(90%),位于颈总动脉其次3人(6%),位于颈内动脉2人(4%)。
结论:通过本研究,我们认为有代谢综合征患者更加容易患粥样硬化斑块,而年龄、性别、吸烟史及家族史与代谢综合征无明显联系。在本研究中,合并代谢综合征的颈动脉粥样硬化斑块病人的斑块96%纤维帽是完整的,只有4%是不完整的,56%患者斑块中心有钙化,斑块主要发生于颈动脉分叉处:2%患者斑块内有血肿,需要密切随访及内、外科治疗。所以本研究中代谢综合征患者的颈动脉粥样硬化斑块大部分是稳定的,少数是不稳定的,有待于大样本及前瞻性研究进一步证实。
PartⅠMulti-contrast MRI Imaging Characterize the Carotid artery in Rabbits
Purpose:Our aim was to explore the feasibility and accuracy of multi-contrast MRI imaging((TOF、T1WI、T2WI、PDWI) to show the carotid artery of rabbits.
Material and Methods:20 New Zealand rabbits underwent multi-contrast MRI scan and DSA respectively.The images of the same slice were compared and the diameter of the ipsilateral carotid artery was measured.At the same time,the source images of T1WI,T2WI and TOF were reconstructed by the means of MIP and MPR.
Results:The mean of diameter is 2.42±0.15mm measured by MRI and 2.15±0.08mm by DSA.The two measurements were highly correlated,with a correlation coefficient of 0.749(P＜0.01) The reconstructed imagings is excellent.
Conclusions:Multi-contrast MRI is an noninvasive technology which can evaluate the diameter and characterize the wall signal of carotid artery accurately.Combined with vascular reconstruction technology,the new multi-contrast MRI is going to take the place of DSA to diagnose atherosclerosis.In the conclusion,the new and promising technology will facilitate build an atherosclerotic animal model.And future MRI studies may improve our understanding of the pathophysiology of atherosclerosis and its relationship with cerebral ischemia in human.
PartⅡEstablishing experimental atherosclerosis and evaluated by serial MRI
Purpose:Establishing the experimental carotid atherosclerosis of New Zealand rabbits is to explore the feasibility of this method and evaluated it by phased array coil according to histology,which is helpful to study the relationship between carotid atherosclerosis and cerebral ischemia diseasse.
Material and Methods:After the initiation of a high cholesterol diet for 8 weeks,20 rabbits underwent balioon injury of common carotid artery.The trauma of vascular was examined by MRI seven days later after the surgery.We continued to feed the rabbits with a high cholesterol diet for 2 month and examined the carotid artery by MRI every 2 weeks.At the end of the study,the rabbits were killed by an intravenous overdose of fluanizone and phentany.Tissue samples from each carotid artery were compared with the imagings of the rabbits.
Results:There are three rabbits died in the feeding and four died after balloon injury,ln the summary,achievement ratio of this experimental model is 75%(12/16).We can see high signal density in the wall of trauma vascular in the first MRI(7 days after surgery).In the second to sixth MRI,intimal thickeness can be seen.The accumulation of foam cells results in the formation of fatty streaks,Smooth muscle cells immigrate from the medial layer into the subendothelial space where they may proliferate,ingest modified lipoproteins and contribute to lesion development,which is similar to the lesion in human vessel.
Conclusions:It is feasible to establish experimental atherosclerosis combinating a high cholesterol diet with balloon injury.MRI is a good tool to examine the trauma vessel and carotid atherosclerosis.
PartⅢCarotid MRI technique:Comparative Research of QIR
PURPOSE:In order to eliminate motion and flow artifacts,reduce scan time,and improve spatial resolution,we apply QIR-FSE and FSE only with flow saturation in comparative research.
MATERIALS AND METHODS:There are three patients went through this researsh.We used both QIR-T1WI FSE and TIWI FSE only with flow saturation in each patient.We accquired 18 images in total.Three attending doctors devide these images into five qualities according to having artifacts or not.Five score -no artifact;four score-flow artifact in only one side,but no motion artifact;three artifact - flow artifact in both sides,but no motion artifact,two score-flow artifact and motion artifact in only one side;one score-flow artifact and motion artifact in both sides.We used non-parametric test to analyse results.
RESULTS:The means of QIR—FSE T1WI is 4.6 and FSE T1WI 2.6.P＜0.05.There is significant difference in statistical analysis.
CONCLUSION:In conclusion,the qualitity of image with QIR-FSE T1WI is better than images with T1WI FSE.In-flow signal were eliminate effectively with QIR-FSE T1WI,which make the images more clearer.,especially in enhance MRI scan.
PartⅣCharacteristics of Carotid Plague MRI in Metabolic Syndrome
PURPOSE:To clarify the relationship between metabolic syndrome and carotid atherosclerosis plague,we design a comparative research to test this relationship.
MATERIALS AND METHODS:Sixty patients were chosen in the research according to WHO defination on Metabolic Syndrome.They all took MRI on both carotid artery and head.We apply Student's t tests and Fisher's exact test in analyzing the data.
RESULTS:The mean age of patients with atherosclerosis plague is 70.0±9.7,whereas patients without atherosclerosis plague is 69.7±7.6.There are 54.2%patients with carotid atherosclerosis plague,which are male.There are 58.3%patients without carotid atherosclerosis plague,which are male.There are 41.7%patients smoking with carotid atherosclerosis plague.There are 41.7%patients smoking without carotid atherosclerosis plague.Among the patients with atherosclerosis plague,there are 75.0%patients with metabolic syndrome.Among the patients without atherosclerosis plague,there are 41.7% patients with metabolic syndrome.P=0.026.Among the patients with atherosclerosis plague,there are 37.5%patients having family history.Among the patients without atherosclerosis plague,there are 36.7%patients with metabolic syndrome having family history.There are 46 patients with carotid atherosclerosis plague,which have thick and intact fiber cap. There are 2 patients with carotid atherosclerosis plague,which have thin and rupture fiber cap.There are one patient with carotid atherosclerosis plague,which have haemorrhage in plague.There are 36 patients with carotid atherosclerosis plague,which have calcification in the plague.
CONCLUSION:In this research,patients with metabolic syndrome have the tendency to suffer from carotid atherosclerosis plague.And the characteristic of the plague are stable in most with intact fiber cap and calcification in the center of the plague.Most plague located in the bifurcation of carotid artery.Our conclusion need to be tested in large sample through prospective research in the future.
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