三维高分辨率磁共振管壁成像在评估非狭窄性颅内动脉粥样硬化所致缺血性脑卒中复发中的价值

目的：本部分研究旨在利用三维高分辨率磁共振管壁成像分析易复发和稳定颅内非狭窄性动脉粥样硬化斑块的影像特征差异，为临床缺血性卒中复发预判提供影像学依据。方法：自2019年1月至2021年8月前瞻性纳入了42例非狭窄性颅内动脉粥样硬化斑块患者（年龄60.38±10.97岁，男性患者31例）。所有患者在发病4周内行首次3D hr-VW-MRI检查，3个月后行随访3D hr-VW-MRI检查。基于T1WI和T1WI增强图像分析定量特征，形态学特征包括最小管腔面积、斑块体积、最大管壁厚度、最小管壁厚度、狭窄率、斑块负荷、重构率、偏心指数及强化率。对比分析复发组与稳定组各个定量特征之间的差异。结果：复发组患者11例，稳定组患者31例。形态学特征显示，复发组的斑块体积、偏心指数、责任斑块最狭窄层面斑块强化率、责任斑块整体强化率及斑块内出血发生率均高于稳定组（P均＜0.05）。复发组和稳定组之间最小管腔面积、狭窄率、斑块负荷、重构率在复发组和稳定组之间无明显统计学差异（P均＞0.05）。结论：三维高分辨率磁共振管壁成像能够有效评估非狭窄性动脉粥样硬化复发性卒中患者的斑块形态学特征，可为临床预防卒中复发提高重要参考。

Value of 3D high resolution vessel wall magnetic resonance imaging in evaluating recurrent ischemic stroke caused by non-stenotic intracranial atherosclerosis

Objective To analyze the plaque characteristics of patients with recurrent or stable ischemic stroke caused by non-stenotic intracranial atherosclerosis using three dimensional high resolution vessel wall magnetic resonance imaging (3D hr-VW-MRI).Methods A total of 42 patients with ischemic stroke caused by non-stenotic intracranial atherosclerosis in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2019 to Aug. 2021 were prospectively enrolled. The patients were examined by 3D hr-VW-MRI within 4 weeks of onset and after 3-month follow-up. Imaging features of plaques, including luminal area, maximum wall thickness and minimum wall thickness at the most stenotic site, stenosis rate, plaque burden, remodeling index, eccentricity index, enhancement ratio at the most stenotic site, enhancement ratio of the whole plaque, plaque volume, and intraplaque hemorrhage, were measured based on plain and contrast-enhanced T1 weighted imaging (T1WI). With regular medical treatment, the patients were divided into recurrent group and stable group according to whether they had transient ischemic attack or cerebral infarction (hyperintensity on cranial magnetic resonance diffusion weighted imaging images with corresponding ischemic stroke symptoms) on the ipsilateral side of the original ischemic stroke. The differences in imaging features of plaques between recurrent group and stable group were analyzed.Results There were 11 patients in the recurrent group and 31 patients in the stable group. The eccentricity index, enhancement ratio at the most stenotic site, enhancement ratio of the whole plaque, plaque volume and intraplaque hemorrhage incidence in the recurrent group were significantly higher than those in the stable group (all P < 0.05). There were no significant differences in the luminal area, maximum wall thickness or minimum wall thickness at the most stenotic site, stenosis rate, plaque burden, or remodeling index between the 2 groups (all P > 0.05).Conclusion 3D hr-VW-MRI can effectively evaluate the plaque characteristics of patients with recurrent ischemic stroke caused by non-stenotic intracranial atherosclerosis, providing reference for clinical prevention of ischemic stroke recurrence.