颈动脉斑块形态与脑梗塞关系的第二代双源CT双能量CTA研究

目的采用双能量CT血管成像（dual energy CTA,DECTA）研究颈动脉斑块形态特征,并探讨除狭窄度之外与缺血性脑血管病相关的风险因子。方法对412例有脑缺血性症状的患者,使用双能量CTA进行扫描,运用CT重建技术进行重建,评估颈动脉斑块的形态特征和颈动脉狭窄度,其中包括斑块密度,表面形态,钙化程度,并记录有无管腔内栓子形成。斑块表面形态分为平滑,不规则和溃疡三类。结果 412个患者217个有右侧半球症状,195有左侧半球症状。颈动脉梗阻（P=0.01,OR=6.72）,重度狭窄（70%-99%）（P=0.05,OR=2.10）,和溃疡斑块形成（P=0.04,OR=0.97）高度预示同侧脑缺血症状。多变量Logistic回归分析结果溃疡斑块（P=0.05,OR=0.92）与同侧脑缺血症状相关,平滑斑块（P=0.05,OR=0.65）及重度钙化斑块（P=0.04,OR=0.67）与同侧无症状具有相关性。结论DECTA成像可以对颈动脉粥样硬化斑块表面形态进行分类,斑块表面溃疡与脑缺血病变具有相关性,平滑斑块及重度钙化斑块也具有预测作用。

Evaluation of the Relation between Carotid Artery Plaque Morphology and Ischemic Cerebrovascular Disease Using Dual Energy CT Angiography

Objective To identify a set of CT features of carotid atherosclerotic plaques that is significantly associated with ischemic stroke in addition to stenosis by using dual energy CTA. Methods Four hundred twelve patients presenting with hemispheric ischemic symptoms and having a dual energy CTA that included imaging of both carotid arteries. Scans were interpreted for morphologic features, such as plaque attenuation, surface, presence and degree of calcification, and intraluminal thrombus （ILT） in addition to stenosis. The plaque surface was classified as：smooth, irregular and ulcerated. Results Four hundred twelve patients were identified who had a clear hemispheric event. 217 patients had right-hemispheric symptoms, and 195 patients had left-hemispheric symptoms. Univariable X2 analysis showed that carotid occlusions（P=0.01,OR=6.72）, high-grade stenosis （70%-99%） （P=0.05,OR=2.10）, and ulcerated plaque （P=0.04,OR=0.97） were highly predictive of the symptomatic side. In a multivariable logistic regression model, the presence of ulcerated plaque （P=0.05,OR=0.92）was found to be significantly associated with the symptomatic side and the presence of smooth surface（P=0.05,OR=0.65） and extensive calcification（P=0.04,OR=0.67）, with the asymptomatic carotid artery. Conclusion DECTA allows the classification of atherosclerotic carotid plaque surface, ulcerated plaque is highly predictive of the symptomatic side in carotid disease.