颈动脉粥样硬化不稳定斑块异质性的病理研究及高分辨MRI影像特点分析

目的通过对颈动脉粥样硬化（CAS）不稳定斑块内不同成分的病理研究，分析斑块异质性红斑块不稳定化过程中的作用，及其高分辨MRI影像特点，为颈动脉内膜切除术（CEA）术前判断斑块稳定性及防止斑块不稳定化和术后再狭窄提供参考。方法对经CEA手术获取的CAS斑块进行H-E和Masson染色，观察斑块内纤维帽、脂质坏死池、出血、钙化和纤维化等成分的特点，并与术油颈动脉高分辨MRI影像时照，分析其影像学特征。结果共取得28块斑块，均为复杂性斑块，纤维帽不完整，存在不同程度的脂质坏死池和纤维化，其中16例出现斑块内出血，19例出现斑块内钙化；斑块内不同成分具有不同的高分辨MRI影像特征。结论不稳定斑块的主要特征在于其病理成分的异质性，即纤维帽的破损、广泛的脂质坏死、斑块内出血、弥漫性钙化和纤维化等成分并存，斑块的异质性是导致其易于产生栓子或诱发血栓形成、晚期呈急性进展并迅速发展为颈动脉闭塞等临床特征的主要原因，也是其高分辨MRI影像特点的主要形成原因。

Pathological study of the heterogeneity and analyses of the high resolution MRI characteristics of the unstable carotid atherosclerotic plaques

Objective To analyze the role of the heterogeneity in the process of the plaques' instability and the genesis of the high resolution MRI characteristics through the pathological study of the different components in the unstable carotid atherosclerotic plaque, and provide references for the estimation of plaque stability pre-carotid endarterectomy and for the precaution of the plaque's instability and post-operation restenosis. Methods The pathological methods of H-E and Masson staining are employed on the unstable carotid atherosclerotic plaques obtained through carotid endarterectomy to observe the intraplaque components of fibrous cap, necrosis, lipid pool, hemorrhage, calcification and fibrosis, and compare their characteristics with high resolution MRI images to analyze the cause of formation of their MRI characteristics. Results All the 28 plaques obtained through operation are complex plaques; all have a ruptured fibrous cap and various degree of necrotic core, lipid pool and fibrosis, in which 16 with intraplaque hemorrhage and 19 with calcification. Different intraplaque components have different high resolution MRI characteristics. Conclusions The major characteristics of the unstable plaques are the heterogeneity of their pathological components, including the co-existence of the rupture of the fibrous cap, the intraplaque necrosis, hemorrhage, diffuse calcification and fibrosis, which result in the susceptibility of the thrombus formation, and the rapid development to the block of carotid artery, And also the major causes of the formation of their high resolution MRI characteristics.