汉族人颈动脉粥样硬化斑块高分辨率MRI与病理特征的对照研究

目的 探讨高分辨率MRI对颈动脉粥样硬化斑块性质、形态评估的准确性,以及影响斑块稳定性的病理学因素。方法 对2013年2月—2015年2月聊城市人民医院103例颈动脉内膜剥脱术患者行前瞻性研究。术前均行颈动脉高分辨率MRI多序列扫描,术后对斑块切片行HE染色、油红O染色、Masson三染以及CD68免疫组织化学检测。根据病理结果,分为易损斑块组和稳定斑块组,并和MRI检测结果比较。结果 103例颈动脉粥样硬化斑块中共有易损斑块42例、稳定斑块61例。与稳定斑块组比较,易损斑块组胶原含量明显降低(10.37%±3.19% vs 17.02%±4.56%),而脂质含量则明显升高(19.14%±3.26% vs 13.99%±3.47%),CD68表达明显增加,差异均有统计学意义(t=8.169、7.585, P值均<0.01)。与稳定斑块组比较,易损斑块组平均管腔面积、最小管腔面积、平均管壁面积、最大管壁面积、平均管壁厚度、最大管壁厚度、平均标准化管壁指数、最大标准化管壁指数均明显升高或降低,差异均有统计学意义(t=5.099、7.513、4.068、2.535、3.182、3.503、10.868、6.233, P值均<0.05)。与病理检查比较,MRI检查颈动脉粥样硬化斑块中富含脂质的坏死核、斑块内出血、钙化检出率偏低,而纤维帽表面破裂检出率偏高,但差异均无统计学意义(P值均＞0.05)。结论 颈动脉粥样硬化易损斑块与稳定斑块在病理形态学方面存在显著差异,将高分辨率MR多序列技术相结合,能更准确、更全面地测量其管壁结构、斑块成分以及体积,可用于斑块的风险评估。

The comparison study of the high resolution MRI and pathology of Han population with carotid atherosclerotic plaques

Objective To explore the high resolution MRI of multi-sequence technology to evaluate carotid atherosclerotic plaques characteristics, and the accuracy of the assessment form, as well as the pathology factors which influence the stability of plaques.Methods One hundred and three patients with carotid endarterectomy were examined with carotid high-resolution MRI scanning of multiple sequence before surgery, and laque sections were detected with hematoxylin-eosin staining,Oil Red O staining,Masson staining and CD68 immuno- histochemistry after surgery. According to pathological Results, the patients were divided into vulnerable plaques group and stable plaques group, and the rasults were compared with MRI scanning Results.Results There were 42 cases with vulnerable plaques and 61 cases with stable plaques in 103 cases with carotid atherosclerotic plaques. Compared with the stable plaques group, the collagen content in vulnerable plaques group was significantly lower (10.37%±3.19% vs 17.02%±4.56%), while the lipid content was significantly higher (19.14%±3.26% vs 13.99%±3.47%), and the expression of CD68 increased significantly. The differences were statistically significant (t=8.169, 7.585, P<0.01). Compared with stable plaques, in vulnerable plaque group, the average lumen area, the minimum lumen area, the average wall area, the maximum wall area, the average wall thickness, the maximum wall thickness, the average standardized wall index and the maximum standardization wall index were significantly higher or lower. The differences were statistically significant(t=5.099, 7.513, 4.068, 2.535, 3.182, 3.503, 10.868, 6.233, all P values<0.05). Compared with the pathology group, MRI the detection rate of lipid-rich the necrotic core, plaque hemorrhage and calcification in carotid atherosclerotic plaque were lower, while the detection rate of surface rupture of the fibrous cap was higher. But there were no statistically significant differences (all P values>0.05).Conclusions There is significant difference between carotid atherosclerotic vulnerable plaques and stable plaques in pathological terms. Combining with high-resolution MRI of multi-sequence technology can be more accurate and more comprehensive to measur the wall structure, the composition and volume of plaque, which can be used for risk assessment of plaque.