影像学检查对缺血性脑血管病患者颈动脉粥样硬化斑块的研究

目的采用双源CT血管造影(CTA)和高分辨MRI,探讨缺血性脑血管病患者颈总动脉分叉处粥样硬化斑块的性质、成分和动脉管腔狭窄程度与缺血性脑血管病的关系。方法选择缺血性脑血管病患者40例,经颈部CTA检测出颈总动脉分叉处粥样硬化斑块并伴管腔狭窄,再接受MRI扫描;分析颈动脉粥样斑块的性质、成分及管腔狭窄程度。结果 40例患者中,CTA检出斑块61个,其中混合性斑块31个;钙化性斑块18个;软斑块12个。高血压30例,检出斑块49个;无高血压10例,检出斑块12个。MRI检出斑块61个,其中Ⅲ型14个;Ⅳ～Ⅴ型23个,Ⅵ型6个;Ⅶ型18个。斑块内溃疡6例;颈动脉粥样硬化斑块造成同侧急性脑梗死14例,双侧颈动脉斑块造成双侧脑梗死10例,一侧颈动脉检出粥样斑块而对侧发生脑梗死2例。结论缺血性脑血管病患者颈动脉粥样硬化斑块主要以混合性斑块为主,双侧好发;高血压患者斑块发生率高于无高血压患者;颈动脉粥样硬化斑块造成同侧脑梗死发生率较高。

Study on atherosclerotic plaque at carotid bifurcation by imaging examination in patients with ischemic cerebrovascular disease

Objective To investigate the relation of the ischemic cerebrovascular disease (ICVD) with the character of carotid bifurcation atherosclerotic plaque and the grade of stenosis of carotid artery using dual-source CTA(DSCTA) and high-resolution MRI.Methods Forty patients with ICVD underwent carotid artery high-resolution MRI after DSCTA.All patients had varying degrees of carotid bifurcation atherosclerosis.The component of carotid atherosclerotic plaque and the grade of stenosis of carotid artery were measured.Results Among 40 patients,CTA detected 61 plaques,of which,31 were combined calcified and soft plaques,18 were calcified plaques,12 were soft plaques.In 30 hypertensive patients,49 plaques were detected,in 10 patients without hypertension,12 plaques were detected.MRI detected 61 plaques,of which,14 were type Ⅲ ,23 were type Ⅳ-Ⅴ,6 were typeⅥ ,18 were typeⅦ.Six cases showed plaque within the ulcer.Carotid atherosclerotic plaque caused ipsilateral acute cerebral infarction in 14 cases,10 cases had cerebral infarction caused by bilateral carotid artery plaque.Two cases of cerebral infarction had plaque detected in contralateral carotid artery.Conclusions The carotid artery plaque in patients with ICVD is mainly combined calcified and soft plaque,which is easy to occurr in bilateral carotid arteries.Carotid atherosclerotic plaque caused high incidence of ipsilateral cerebral infarction.