MR高分辨血管壁成像与椎基底动脉延长扩张症患者管壁斑块易损性的相关性研究

Correlation of MR high-resolution vessel wall imaging with wall plaque vulnerability in patients with vertebrobasilar dolichoectasia

目的 探究磁共振高分辨血管壁成像(HRMR-VWI)与椎基底动脉延长扩张症(VBD)患者管壁斑块易损性的相关性。方法 选取2021年5月—2022年1月衡水市人民医院经数字减影血管造影(DSA)确诊存在管壁斑块的VBD患者114例,均行HRMR-VWI检查,统计管壁斑块分布情况、斑块易损性及斑块特征,分析HRMRVWI诊断VBD管壁斑块位置、斑块易损性的准确度,比较稳定斑块和易损斑块患者一般资料、HRMR-VWI测量的基底动脉(BA)直径、BA分叉高度、BA曲折程度,分析BA直径、BA分叉高度、BA曲折程度与管壁斑块易损性的相关性。结果 存在管壁斑块的VBD患者管壁斑块分布以背侧壁为主(57.74%),其次为前壁(14.88%)、右壁(11.90%)、左壁(10.12%)、环壁(5.36%);易损斑块特征以斑块内出血为主(46.15%),其次为纤维帽断裂(28.21%)、大脂质核心(25.64%);HRMR-VWI诊断VBD管壁斑块位置、斑块易损性的准确度均为100.00%;易损斑块患者BA直径(6.13±0.84)mm、BA分叉高度3级占比(51.28%)、BA曲折程度重度占比(56.41%)均高于稳定斑块患者(P<0.05);HRMR-VWI检查VBD患者BA直径、BA分叉高度、BA曲折程度均与管壁斑块易损性呈正相关(r=0.612、0.569、0.547,P<0.05)。结论 HRMR-VWI能准确判断VBD患者管壁斑块位置、斑块易损性,且BA直径、BA分叉高度、BA曲折程度均与管壁斑块易损性有关,HRMR-VWI检查可准确评估患者上述指标,为临床判断斑块易损性提供科学依据。

Objective To investigate the correlation between MR high-resolution vessel wall imaging(HRMR-VWI)and wall plaque vulnerability in patients with vertebrobasilar dolichoectasia(VBD).Methods 114 patients with VBD diagnosed by digital subtraction angiography(DSA)with wall plaques underwent HRMR-VWI on the very day of admission to measure the diameter,bifurcation height,and tortuosity of basilar artery(BA),and to judge the vulnerability of plaques.Spearman's correlation analysis was used to study the correlation of BA diameter,bifurcation height,and degree of curvature with plaque vulnerability.Results The distribution of canal wall plaques in the VBD patients with canal wall plaques was predominantly in the dorsal wall(57.74%),followed by the anterior wall(14.88%),right wall(11.90%),left wall(10.12%),and circumferential wall(5.36%).The vulnerable plaque characteristics were predominantly intraplaque hemorrhage(46.15%),followed by fibrous cap fracture(28.21%)and large lipid core(25.64%).The accuracy of HRMR-VWI in diagnosing the location of plaques in the canal wall of VBD and in diagnosing the plaque susceptibility were both 100.00%.The average BA diameter was(6.13±0.84)mm.51.28%of the BA bifurcation height was at grade 3,and 56.41%of the BA curvature degree was severe in the patients with susceptible plaques,both proportions were significantly higher than in the patients with stable plaques(all P<0.05).Spearman’s correlation analysis showed that the BA diameter,BA bifurcation height,and BA curvature degree examined by HRMR-VWI in the VBD patients were all positively correlated with tubular wall plaque vulnerability(r=0.612,0.569,0.547,all P<0.05).Conclusion HRMR-VWI accurately determines the location of plaque in the canal wall and the plaque vulnerability in VBD patients,and the BA diameter,BA bifurcation height and BA curvature degree are all related to the canal wall plaque vulnerability.