高分辨颈动脉磁共振成像预测颈内动脉斑块纤维帽破裂患者脑血管事件危险度研究

High-resolution carotid magnetic resonance imaging to predict the risk of cerebrovascular events in patients with ruptured fibrous cap of internal carotid artery plaque

目的探讨高分辨颈动脉磁共振成像(HRCMRI)预测颈动脉斑块纤维帽破裂患者脑血管事件的危险度。方法回顾性分析2017年1月至2020年3月于本院行HRCMRI检查的100例颈内动脉轻中度(<70%)狭窄患者的临床资料,其中稳定斑块与斑块纤维帽破裂患者各50例。比较稳定斑块与斑块纤维帽破裂患者同侧脑血管事件发生率,分析稳定斑块与斑块纤维帽破裂患者HRCMRI影像学特征。结果稳定斑块患者1年内脑血管事件发生率为24.0%,低于斑块纤维帽破裂患者的60.0%,差异有统计学意义(P<0.05)。稳定斑块患者HRCMRI表现为:斑块表面光滑;纤维帽较厚,增强扫描呈轻中度线样或均匀强化;无较大脂质核心(脂质核面积不超过斑块40%);无斑块内出血。斑块纤维帽破裂患者HRCMRI表现为:线样强化的纤维帽连续性中断,龛影形成,斑块表面不规则,局部凹陷,凹陷区即龛影在黑血序列上为低信号,在亮血序列上为高信号。结论HRCMRI技术可预测颈动脉斑块纤维帽破裂患者同侧脑血管事件发生情况,可为临床及时治疗提供参考。

Objective To investigate the high-resolution carotid magnetic resonance imaging(HRCMRI)to predict the risk of cerebrovascular events in patients with ruptured fibrous cap of internal carotid artery plaque.Methods The clinical data of 100 patients with mild-to-moderate stenosis of internal carotid artery(<70%)who underwent HRCMRI examination in our hospital from January 2017 to March 2020 were retrospectively analyzed,including 50 patients with stable plaque and 50 patients with ruptured fibrous cap of plaque.The incidence of ipsilateral cerebrovascular events in patients with stable plaque and ruptured fibrous cap of plaque was compared,and the imaging characteristics of HRCMRI in patients with stable plaque and rupture of plaque fibrous cap were analyzed.Results The incidence of cerebrovascular events within 1 year in patients with stable plaque was 24.0%,which was lower than 60.0%in patients with ruptured fibrous cap of plaque,and the difference was statistically significant(P<0.05).The HRCMRI of patients with stable plaque showed that the plaque surface was smooth;the fiber cap was thick,and the enhanced scan showed mild to moderate linear or uniform enhancement;no large lipid core(the area of lipid core does not exceed 40%of plaque);no intraplaque hemorrhage.The HRCMRI of patients with ruptured fibrous cap of plaque showed that the continuous of fibrous cap with line enhancement was interrupted,formation of niche shadow;the irregular surface of plaque,and local depression,the depressed area(niche)was low signal on black blood sequence and high signal on bright blood sequence.Conclusion HRCMRI technology can predict the occurrence of ipsilateral cerebrovascular events in patients with ruptured fibrous cap of carotid plaque,which can provide effective evidence for timely clinical treatment.