三维高分辨率磁共振管壁成像在评估非狭窄性颅内动脉粥样硬化所致缺血性脑卒中复发中的价值

Value of 3D high resolution vessel wall magnetic resonance imaging in evaluating recurrent ischemic stroke caused by non-stenotic intracranial atherosclerosis

目的利用三维高分辨率磁共振管壁成像(3D hr-VW-MRI)分析复发性和稳定性非狭窄性颅内动脉粥样硬化所致缺血性脑卒中患者的斑块特征。方法前瞻性纳入2019年1月至2021年8月于海军军医大学(第二军医大学)第一附属医院就诊的非狭窄性颅内动脉粥样硬化所致缺血性脑卒中患者42例。患者在发病4周内行首次3D hr-VW-MRI检查,3个月后随访时再次行3D hr-VW-MRI检查。基于T1加权成像(T1WI)平扫和增强图像测量斑块的影像学特征,包括最狭窄层面管腔面积、最狭窄层面最大管壁厚度、最狭窄层面最小管壁厚度、狭窄率、斑块负荷、血管重构指数、偏心指数、最狭窄层面斑块强化率、斑块整体强化率、斑块体积及斑块内出血情况。在规律内科治疗的情况下,根据患者首次缺血性脑卒中同侧责任血管区是否出现短暂性脑缺血发作或再次发生脑梗死(头颅磁共振弥散加权成像显示高信号并出现相应缺血性脑卒中症状),分为复发组和稳定组。对比分析复发组与稳定组患者各项斑块影像学特征的差异。结果复发组患者11例、稳定组患者31例。复发组患者的偏心指数、最狭窄层面斑块强化率、斑块整体强化率、斑块体积及斑块内出血发生率均高于稳定组(P均<0.05),两组的最狭窄层面管腔面积、最狭窄层面最大管壁厚度、最狭窄层面最小管壁厚度、狭窄率、斑块负荷、血管重构指数差异均无统计学意义(P均>0.05)。结论3D hr-VW-MRI能够有效评估复发性非狭窄性颅内动脉粥样硬化所致缺血性脑卒中患者的斑块特征,可为临床预防缺血性脑卒中复发提供参考。

Objective To analyze the plaque characteristics of patients with recurrent or stable ischemic stroke caused by non-stenotic intracranial atherosclerosis using three dimensional high resolution vessel wall magnetic resonance imaging(3D hr-VW-MRI).Methods A total of 42 patients with ischemic stroke caused by non-stenotic intracranial atherosclerosis in The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.2019 to Aug.2021 were prospectively enrolled.The patients were examined by 3D hr-VW-MRI within 4 weeks of onset and after 3-month follow-up.Imaging features of plaques,including luminal area,maximum wall thickness and minimum wall thickness at the most stenotic site,stenosis rate,plaque burden,remodeling index,eccentricity index,enhancement ratio at the most stenotic site,enhancement ratio of the whole plaque,plaque volume,and intraplaque hemorrhage,were measured based on plain and contrast-enhanced T1 weighted imaging(T1WI).With regular medical treatment,the patients were divided into recurrent group and stable group according to whether they had transient ischemic attack or cerebral infarction(hyperintensity on cranial magnetic resonance diffusion weighted imaging images with corresponding ischemic stroke symptoms)on the ipsilateral side of the original ischemic stroke.The differences in imaging features of plaques between recurrent group and stable group were analyzed.Results There were 11 patients in the recurrent group and 31 patients in the stable group.The eccentricity index,enhancement ratio at the most stenotic site,enhancement ratio of the whole plaque,plaque volume and intraplaque hemorrhage incidence in the recurrent group were significantly higher than those in the stable group(all P<0.05).There were no significant differences in the luminal area,maximum wall thickness or minimum wall thickness at the most stenotic site,stenosis rate,plaque burden,or remodeling index between the 2 groups(all P>0.05).Conclusion 3D hr-VW-MRI can effectively evaluate the plaque characteristics of patients with recurrent ischemic stroke caused by non-stenotic intracranial atherosclerosis,providing reference for clinical prevention of ischemic stroke recurrence.