Zhongguo cuzhong zazhi (Aug 2019)
基于多对比度磁共振血管壁成像技术对前循环症状性颅内外动脉粥样硬化斑块特征的对比研究 Characteristics of Symptomatic Intra- and Extracranial Atherosclerotic Plaques in Anterior Circulation Based on Multi-contrast Magnetic Resonance Vascular Wall Imaging
Abstract
【摘要】 目的 基于多对比度MRI血管壁成像技术，比较颅内动脉、颅外动脉粥样硬化斑块的特征。 方法 回顾经3D多对比度头颈联合MRI血管壁成像检查确定存在前循环症状性颅内外动脉粥样硬化斑块的患者资料。观察斑块分布情况；测量斑块负荷，包括斑块最大管壁厚度、长度、管腔狭窄程度；分析斑块内成分，包括脂质坏死核、出血、钙化，对比分析颅内动脉和颅外动脉粥样硬化斑块的影像学特征。 结果 在入组的45例患者中，共检出颅内、外动脉粥样硬化斑块203个，其中颅外动脉斑块156个（76.8%），颅内动脉斑块47个（23.2%）。颅外动脉粥样硬化斑块最大管壁厚度[（3.2±1.0）mm vs （1.9±0.4）mm，P<0.001]、斑块长度[10.7（7.5～13.7）mm vs 4.3（2.6～6.3）mm，P<0.001]大于颅内动脉，而颅内动脉管腔狭窄程度[28.0%（20.0%～38.5%）vs 18.8%（10.8%～30.5%），P<0.001]重于颅外动脉。颅外动脉粥样硬化斑块内脂质坏死核的发生率高于颅内动脉（66.0% vs 21.3%，P<0.001），而斑块内出血的发生率颅内动脉高于颅外颈动脉（27.7% vs 13.5%，P=0.027）。 结论 在合并有颅内外动脉粥样硬化斑块的患者中，颅外动脉的斑块最大管壁厚度、斑块内脂质坏死核的发生率高于颅内动脉，而管腔狭窄程度、斑块内出血的发生率低于颅内动脉。 【Abstract】 Objective To compare the characteristics of intra- and extracranial plaques using 3D multi-contrast magnetic resonance vessel wall imaging in patients with symptomatic intra- and extracranial atherosclerotic diseases. Methods The data of patients with symptomatic intra-and extracranial carotid artery culprit plaques identified by MR vessel wall imaging were retrospectively analyzed. The distribution, burden and components of plaques were analyzed. The plaque burden including the maximum wall thickness (Max WT), plaque length and vessel stenosis were measured. Plaque components such as lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH) and calcification on MRI were evaluated. The imaging characteristics of plaques between intracranial and extracranial arteries were compared. Results In total, 45 patients were recruited and 203 atherosclerotic plaques were detected, including 156 extracranial plaques (76.8%) and 47 intracranial plaques (23.2%). Max WT [(3.2±1.0) mm vs(1.9±0.4) mm, P<0.001] and plaque length [10.7 (7.5-13.7) mm vs 4.3 (2.6-6.3) mm, P<0.001] of extracranial plaques were significantly larger than that of intracranial plaques. Stenosis degree [28.0 (20.0-38.5)% vs 18.8 (10.8-30.5)%, P<0.001] of intracranial plaques were significantly larger than that of extracranial plaques. Compared with intracranial plaques, extracranial plaques showed more higher rate of LRNC (66.0% vs 21.3%, P<0.001) and lower rate of IPH (13.5% vs 27.7%, P=0.027). Conclusions For patients with atherosclerotic culprit plaques and symptomatic intracranial and extracranial artery diseases, extracranial plaques commonly have greater Max WT, higher rate of LRNC, less severe stenosis and lower rate of IPH than intracranial plaques.
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