颅内动脉粥样硬化斑块易损性的三维高分辨磁共振研究

Three-dimensional High Resolution Magnetic Resonance on the Vulnerability of Intracranial Atherosclerotic Plaque

目的探讨颅内责任斑块与非责任斑块在管壁重构、强化程度方面的差异,确定斑块易损性的影像学标志。资料与方法选取天津医科大学总医院拟行头部加颈部磁共振血管成像检查的疑似动脉粥样硬化患者44例,注入对比剂前后分别加扫3D-T1-SPACE序列。44例患者中,急性脑梗死21例,短暂性脑缺血发作8例,无症状者15例。进一步将斑块分为责任斑块和非责任斑块,比较两种类型斑块在管壁重构模式与强化程度的差异。结果 44例患者发现47枚斑块,其中责任斑块21枚,非责任斑块26枚。5枚责任斑块及7枚非责任斑块所在管壁出现正性重构,两者发生正性重构的比例差异无统计学意义(X^2=0.059,P=0.808);但责任斑块的斑块负荷高于非责任斑块,差异有统计学意义(t=4.59,P<0.001)。所有21枚责任斑块及23枚非责任斑块出现强化,两者出现强化的比例差异无统计学意义(X^2=2.58,P=0.108);但责任斑块的强化程度高于非责任斑块,差异有统计学意义(t=5.04,P<0.001)。结论斑块强化程度可作为斑块易损性的影像学标志。

Purpose To explore the differences in vascular wall remodeling and enhancement degree of intracranial culprit and non-culprit plaque,and to determine the imaging features of plaque vulnerability.Materials and Methods A total of 44 patients with suspected atherosclerosis who underwent magnetic resonance angiography examination of the head and neck were selected from Tianjin Medical University General Hospital.The 3D-T1-SPACE sequence was added before and after the injection of contrast agent.Of the 44 patients,21 had acute cerebral infarction,8 transient ischemic attack,and 15 had no symptoms.The plaques were divided into culprit plaque and non-culprit plaque,and the difference between the two types of plaques in terms of vascular wall remodeling pattern and degree of enhancement were compared.Results Forty-seven plaques were found in 44 patients,including 21 culprit plaques and 26 non-culprit plaques.Positive remodeling occurred in the vascular wall of the 5 culprit plaques and 7 non-culprit plaques.There was no statistical significance concerning the difference in the proportion of positive remodeling between the two(X^2=0.059,P=0.808).However,the culprit plaque had higher plaque burden than that of the non-culprit plaque,the difference of which was statistically significant(t=4.59,P<0.001).All 21 culprit plaques and 23 non-culprit plaques were strengthened.There was no statistical significance concerning the difference in the proportion of enhancement between the two groups(X^2=2.58,P=0.108),but the enhancement degree of the culprit plaque was higher than that of the non-culprit plaque,the difference of which was statistically significant(t=5.04,P<0.001).Conclusion The degree of plaque enhancement can be used as an imaging feature for plaque vulnerability.