症状性缺血性脑卒中颈动脉斑块成分的 高分辨MRI分析

目的应用高分辨MRI(HRMRI)探讨颈动脉斑块不同成分在症状性缺血性脑卒中病人中的危险性。方法选取2016年1月—2017年6月于我院行超声检查发现存在颈动脉斑块的病人50例,其中女21例,男29例,年龄43~77岁,平均(61.62±7.96)岁。依据病人近3个月来是否发生过与患侧颈动脉相关的缺血性脑卒中临床症状分为有症状组(22例,存在斑块血管40支)及无症状组(28例,50支),所有病人行3.0 T HRMRI以评估颈动脉血管及斑块内成分。采用χ~2检验或t检验对2组病人的临床资料、斑块成分及血管管腔狭窄程度进行比较,采用logistic回归分析缺血性脑卒中病人症状的独立危险因素。结果检出存在斑块纤维帽破溃(FCR)的血管,症状组15支,检出率为37.5%,无症状组8支,检出率为16.0%,症状组FCR的检出率高于无症状组(P0.05)。检出斑块内出血(IPH)的血管,症状组21支,检出率为52.5%,无症状组15支,检出率为30.0%,症状组IPH的检出率高于无症状组(P0.05)。检出存在斑块钙化(CA)的血管,症状组15支,检出率为37.5%,无症状组13支,检出率为26.0%,2组间检出率差异无统计学意义(P0.05)。症状组管腔狭窄程度为57.64%±13.36%,无症状组为53.86%±11.19%,2组间管腔狭窄程度差异无统计学意义(t=1.460,P=0.148)。FCR在症状性缺血性脑卒中危险性最高(OR=3.012),IPH危险性次之(OR=2.478)。结论 HRMRI可以分析斑块内成分,而这些成分是缺血性脑卒中临床症状发生的危险因素,是斑块易损性的表现。

Carotid plaque components assessment by high-resolution MRI in patients with symptomatic ischemic stroke

【Abstract】Objective To study the correlation between the MRI appearances of carotid plaque composition and clinical symptoms of ischemic stroke by using high resolution magnetic resonance imaging . Methods: Fifty cases of carotid plaques were screened by B ultrasound examination from January 2016 to July 2017 ,According to the clinical symptoms of ischemic stroke which are associated with the related side of the carotid artery for the last 3 months，the patients were divided into the Symptomatic group( n=22, Number of arteries with plaques=40 ) and the asymptomatic group( n=28,Number of arteries with plaques=50 ). Then the 3-T high resolution MRI was used to evaluate the carotid artery blood vessel and plaque composition of all patients , and the the correlation between carotid plaque composition and clinical symptoms of ischemic stroke were analyzed by logistic analysis.Results The number of blood vessels with different components of plaque were recorded.The prevalences of FCR (37.5% vs 16.0%; P=0.02)and IPH (52.5% vs 30.0%; P=0.03)were significantly higher in symptomatic than asymptomatic patients. After multivariate analysis, the prevalences of IPH (OR=3.021; P= 0.0325) and FCR (OR=2.478; P=0.0459) were still significantly higher.For Calcification(37.5% vs 26.0%; P=0.21),There was no statistically significant difference in the two groups (P>0.05).Conclusion:HRMRI can effectively identify plaque composition that are associated with symptomatic presentation and may be indicative of plaque vulnerability , and help to diagnose and make treatment plans, which is worthy of clinical application.