高分辨MRI对颅内动脉粥样硬化斑块分布、厚度及稳定性的评估

Evaluation of high-resolution MRI on distribution, thickness and stability of intracranial atherosclerosis plaques

目的探究高分辨率磁共振成像(high-resolution MR imaging,HR MRI)对颅内动脉粥样硬化斑块分布、厚度及稳定性的评估价值,为颅内动脉粥样硬化性病变的临床诊治提供参考依据。方法研究对象为70例行头颅HRMRI检查的后循环缺血患者,其中椎基底动脉系统脑梗死42例、短暂性脑缺血发作28例,分别纳入脑梗死组(n=42)与TIA组(n=28)。分析头颅HRMRI影像学资料,比较两组斑块分布、厚度及稳定性。结果①脑梗死组中分布于腹侧壁、上侧壁的斑块数量高于TIA组,背侧壁、下侧壁斑块数量低于TIA组(P<0.05);②两组血管面积(VA)、管腔面积(LA)、血管最狭窄处(MLN)血管面积(VAMLN)(VAMLN)比较差异无统计学意义(P>0.05);但脑梗死组LAMLN显著低于TIA组,管壁面积(WA)MLN显著高于TIA组(P<0.05);③两组颅内动脉粥样硬化斑块重构方式比较差异无统计学意义(P>0.05);但脑梗死组PA、狭窄率、显著高于TIA组,斑块负荷百分比、RI显著低于TIA组(P<0.05);④脑梗死组易损斑块显著高于TIA组(P>0.05),但两组易损斑块分类比较差异无统计学意义(P<0.05);⑤RI对脑梗死无明显诊断预测价值[AUC 0.591(0.454~0.728)];其余指标用于脑梗死的诊断预测均具一定诊断效能,以WAMLN诊断效能最佳[AUC 0.763(0.649~0.876)]。结论HR MRI评价颅内动脉粥样硬化斑块分布、厚度及稳定性具重要价值,且脑梗死与TIA在斑块分布、血管最狭窄处管腔面积、管壁面积及斑块稳定性上差异显著,并能在一定程度上预测颅内动脉粥样硬化患者脑梗死风险,值得临床重视。

Objective To explore evaluation value of high-resolution MR imaging(HR MRI)in distribution,thickness and stability of intracranial atherosclerosis plaques,and to provide reference basis for diagnosis and treatment of intracranial atherosclerosis lesions.Methods 70 patients with posterior circulation ischemia(PCI)who underwent intracranial HRMRI were enrolled as study objects.Among them,there were 42 cases with cerebral infarction(CI)of vertebral basilar artery system and 28 cases with transient ischemic attack(TIA),who were included into CI group(n=42)and TIA group(n=28),respectively.The intracranial HRMRI imaging data were retrospectively analyzed.The distribution,thickness and stability of plaques were compared between the two groups.Results①The number of plaques distributed at ventral wall and upper wall in CI group was more than that in TIA group,while number of of plaques distributed at dorsal wall and lower wall was less than that in TIA group(P<0.05);②There was no significant difference in vascular area(VA),lumen area(LA)or VA at maximal lumen narrowing(VLNN)(VAMLN)between the two groups(P>0.05).However,LAMLN in CI group was significantly lower than that in TIA group,while wall area(WA)MLN was significantly higher than that in TIA group(P<0.05);③There was no significant difference in reconstruction pattern of intracranial atherosclerosis plaques between the two groups(P>0.05).PA and stenosis rate in CI group were significantly higher than those in TIA group,while percentage of plaque load and RI were significantly lower than those in TIA group(P<0.05);④The vulnerable plaques in CI group were significantly more than those the TIA group(P>0.05).There was no significant difference in classification of vulnerable plaques between the two groups(P<0.05);⑤There was no significant diagnosis or predicting value of RI for CI[AUC 0.591(0.454-0.728)].There was certain diagnostic efficiency of the other indexes for RI.The diagnostic efficiency of WAMLN was the best[AUC 0.763(0.649-0.876)].Conclusion HR MRI is of great value in evaluating distribution,thickness and stability of intracranial atherosclerosis plaques.There are significant differences between CI and TIA in plaque distribution,VAMLN,WA and plaque stability.And it can predict CI risk in patients with intracranial atherosclerosis to certain extent.