颅内动脉粥样斑块易损性的高分辨力MRI研究

The study on the vulnerability of intracranial atherosclerotic plaques by using high resolution MRI

目的采用三维T1WI可变翻转角快速自旋回波(3D T1WI SPACE)序列探讨颅内粥样斑块强化及其管壁重构模式与急性脑缺血发作的关联。方法收集2016年4月—12月间天津医科大学总医院收治的29例急性脑缺血发作的住院病人,其中男25例,女4例,年龄41~80岁,平均(61.7±9.8)岁。所有病人均行3D T1WI SPACE序列检查,评估颅内粥样斑块强化特点,分析颅内动脉管壁重构方式并测量斑块负荷。采用两样本t检验比较责任斑块与非责任斑块强化程度、负荷及动脉管壁重构方式的差异,采用χ~2检验比较责任斑块与非责任斑块处管壁正性重构发生率及2级强化出现率的差异。结果 29例病人发现颅内斑块81个,其中责任斑块29个,非责任斑块52个。责任斑块2级强化出现率明显高于非责任斑块(χ~2=30.73,P=0.001)。责任斑块强化程度明显高于非责任斑块,其强化程度差异有统计学意义(t=7.30,P<0.001)。责任斑块与非责任斑块处管壁正性重构发生率和重构比差异均无统计学意义(分别为χ~2=3.23,P=0.072;t=-1.19,P=0.241),而责任斑块负荷明显高于非责任斑块(t=4.59,P<0.001)。结论颅内责任斑块多呈显著强化,斑块显著强化可能是颅内易损性斑块重要指征之一,这可能对病人急性脑梗死发生做出风险评估,改善其预后。

Objective By using 3D T1 WI SPACE sequenceto investigate whether the acute ischemic cerebral attackhas relation with the enhancement of intracranial plaques and remodeling pattern of intracranial artery wall. Method Twenty-nine patientswith acute ischemic cerebral attack admitted to Tianjin Medical University General Hospital from April 2016 to December 2016 were recruited. All patients performed 3D T1 WI SPACE. Enhanced features of intracranial plaques, remodeling pattern of intracranial artery wall, and plaque burden were assessed. The difference sinenhanced degree, plaque burden, and remodeling rate of artery wall were compared between culprit and non-culprit plaques by independent t-test.The incidence of 2 grade enhancementand artery positive remolding were compared between the culprit and non-culprit plaques by chi-square test. Results Eighty-one intracranial plaques were identified in 29 patients（29 culprit and 52 nonculprit plaques）. The culprit plaques presented a higher incidence of 2 grade enhancement than non-culprit plaques（χ2=30.73,P=0.001）. The culprit plaques had a significantly higher degree of enhancement than the non-culprit plaques（t=7.30,P〈0.001）. The incidence of artery positive remolding and remolding rate of artery showed no significant differences（χ2=3.23,P=0.072; t=-1.19, P=0.241, respectively） between the culprit plaques and non-culprit plaques, but the culprit plaques had a larger burden than the non-culpritplaques（t=4.59, P〈0.001）. Conclusion Most of intracranial culprit plaques show great contrast enhancement.Enhancement of intracranial plaques may serve as an important marker of its stability, and may provide insight into risk for acute cerebral infarction and improve prognosis.