动态增强磁共振成像对瑞舒伐他汀治疗颈动脉粥样硬化斑块的早期疗效评价

Role of dynamic contrast enhanced MRI in assessing early curative effect of rosuvastatin on carotid atherosclerotic plaques

目的动态增强MRI(dynamic contrast enhanced-MRI,DCE-MRI)评价瑞舒伐他汀对颈动脉粥样硬化斑块的疗效。方法 2009年3月~2010年8月解放军总医院门诊MRI证实有明确颈动脉粥样硬化斑块(含脂质核),从未使用过他汀类药物治疗的无症状患者32例,因图像不符合动态模型分析要求而剔除者5例,因层面匹配欠佳而剔除者2例,最终完成入选患者25例。所有患者进行瑞舒伐他汀(5~20mg/d)强化治疗2年,并于筛查时以及治疗3、12、24个月均行颈动脉DCE-MRI检查。测量并分析调脂治疗过程中颈动脉外膜灌流参数血浆容积百分比(Vp值)和血管外膜传输常数(Ktrans值)的变化。结果治疗3、12、24个月Vp值明显低于基线水平,差异有统计学意义(0.09±0.05、0.07±0.04、0.06±0.05 vs 0.12±0.06,P<0.05)。治疗3个月,Vp值降低了25.0%,下降幅度较大;治疗24个月内,Vp值呈现逐渐下降趋势(P<0.05)。与基线水平比较,治疗24个月的Ktrans值轻度降低,差异无统计学意义(P>0.05)。结论 DCE-MRI能够早期评价他汀类药物调脂治疗颈动脉粥样硬化斑块的疗效。

Objective To study the role of dynamic contrast enhanced MRI （DCE-MRI） in assessing early curative effect of rosuvastatin on carotid atherosclerotic plaques. Methods Twenty-five patients with lipid-rich necrotic core carotid atherosclerotic plaques received intensive rosuvastatin treatment （5-20 mg/d） for 2 years,and carotid artery DCE-MRI at baseline before treatment and at months 3,12 and 24 after rosuvastatin treatment. Their adventitial transfer constant （K ） and fractional plasma volume （Vp） were measured and compared during the rosuvastatin treatment. Results The Vp was significantly smaller at months 3,12 and 24 after rosuvastatin treatment than at baseline before rosuvastatin treatment （0.09±0.05,0.07±0.04 and 0.06±0.05 vs 0. 12± 0.06 ,P〈0.05） with a reduction of 25.0% after 3 months of rosuvastatin treatment and a gradual reduction after 24 months of rosuvastatin treatment （P〈0.05）. The adventitial K was mildly reduced after 24 months of rosuvastatin treatment （P〉0.05）. Conclusion DCE-MRI can assess the early curative effect of rosuvastatin on carotid atherosclerotic plaques.