3.0T MRI可评估缺血性脑卒中患者颈动脉粥样硬化的斑块成分

Application value of 3.0T magnetic resonance imaging in carotid atherosclerotic plaque composition examination of ischemic stroke

目的 探究3.0 T MRI在缺血性脑卒中颈动脉粥样硬化斑块成分检查中的临床应用。方法 选择我院及上海交通大学附属第六人民医院2020年6月~2021年4月收治的62例因颈动脉粥样硬化所致的缺血性脑卒中患者作为研究对象。采用3.0 T MRI对所有患者颈动脉血管狭窄处的斑块成分及不同类型斑块的信号特征进行观察、分析,对比稳定斑块、不稳定斑块组成成分的差异。结果 共发现颈动脉粥样硬化斑块119个,斑块分型:Ⅰ~Ⅱ型11个(9.24%),Ⅲ型31个(26.05%),Ⅳ~Ⅴ型24个(20.17%),Ⅵ型37个(31.09%),Ⅶ型16个(13.45%)。所有斑块在MRI上均表现为环形或偏心性管壁增厚,且部分伴有局部新月形或半月形信号突入管腔,不同成分斑块在MRI上的表现各有所不同。所有检出的颈动脉斑块中稳定斑块共计62个,不稳定斑块57个。稳定斑块和不稳定斑块出现钙化的差异无统计学意义(P>0.05),不稳定斑块出现脂质核心、出血、血栓形成以及纤维帽破裂的比例高于稳定斑块,差异有统计学意义(P<0.05)。结论 3.0 T MRI能够对缺血性脑卒中患者的颈动脉粥样硬化斑块内部成分及稳定性作出准确评价,可为缺血性脑卒中的临床预测及病情评价提供重要参考。

Objective To explore the clinical application of 3.0T MRI in carotid atherosclerotic plaque composition examination of ischemic stroke.Methods Sixty-two patients with ischemic stroke caused by carotid atherosclerosis in our hospital and Shanghai Jiaotong University affiliated sixth People’s Hospital from June 2020 to April 2021 were selected.3.0T MRI was used to observe and analyze the plaque composition and signal characteristics of different types of plaques in all patients with carotid artery stenosis.The difference between stable plaque and unstable plaque composition was compared.Results A total of 119 carotid atherosclerotic plaques were found in 62 patients.Patch classification:11 cases were type I-II(9.24%),31 cases were type III(26.05%),24 cases were type IV-V(20.17%),37 cases were type VI(31.09%),16 cases were type VII(13.45%).All plaques showed annular or eccentric wall thickening on MRI,and some of them were accompanied by local crescent or semilunar signal penetrating into the lumen.The manifestations of plaques with different components were different on MRI.There were 62 stable plaques and 57 unstable plaques in all detected carotid plaques.There was no significant difference in the proportion of calcification between stable plaque and unstable plaque(P>0.05).The proportion of lipid core,hemorrhage,thrombosis and fibrous cap rupture in unstable plaque was significantly higher than that in stable plaque(P<0.05).Conclusion3.0T MRI can accurately evaluate the internal composition and stability of carotid atherosclerotic plaques in patients with ischemic stroke.It provide important reference for clinical prediction and disease evaluation of ischemic stroke.