MR颅颈一体化高分辨血管壁成像定量分析在脑卒中相关血管床斑块负荷中应用

Application of quantitative analysis of high-resolution craniocervical vessel wall MR imaging in plaque burdens in stroke-related vascular beds

目的:探究MR颅颈一体化高分辨血管壁成像定量分析在脑卒中相关血管床斑块负荷中应用。方法:选取2018年12月—2020年12月院内诊治缺血性脑卒中患者100例作为研究组,无症状危险人群50例和健康志愿者50例作为对照组,均接受平扫及增强颅颈一体化血管壁成像。记录研究组缺血侧和非缺血侧颈动脉血管壁参数,并以是否发生脑组织不可逆死亡分为良好预后组与不良预后组,分析2组缺血侧颈动脉管壁参数、对疾病预后价值、与美国国立卫生研究院卒中量表(NIHSS)相关性。随访对照组2年,以是否发生缺血性脑卒中分为疾病组和正常组,分析2组颈动脉管壁参数及其预测价值。结果:缺血侧管腔面积小于非缺血侧,血管总面积、管壁面积、管壁标准化指数大于非缺血侧(P<0.05)。良好预后组管腔面积大于不良预后组,血管总面积、管壁面积、管壁标准化指数小于不良预后组(P<0.05)。颈动脉管壁参数联合检测缺血性脑卒中预后ROC曲线下面积AUC(0.824)最大。研究组管腔面积与NIHSS呈负相关关系(P<0.05)。疾病组管腔面积小于正常组,血管总面积、管壁面积、管壁标准化指数大于正常组(P<0.05)。颈动脉管壁参数联合检测无症状危险人群缺血性脑卒中发病ROC曲线下面积AUC(0.838)最大。结论:颈动脉管壁参数对缺血性脑卒中预后及无症状危险人群缺血性脑卒中发病具有较高预测价值,同时管腔面积越大其神经功能损伤越严重。

Objective:To explore the application of high-resolution craniocervical vessel wall MR imaging in the quantitative analysis of carotid artery plaque burdens in stroke-related vascular beds.Methods:One hundred in-hospital patients with ischemic stroke from December 2018 to December 2020 were selected as study group,and 50 asymptomatic risk individuals and 50 healthy volunteers were enrolled as control group.All selected subjects underwent plain and contrast-enhanced highresolution vessel wall MR imaging examinations.Parameters of the carotid vessel wall on the ischemic and non-ischemic sides of study group were recorded.The study group was further classified into good prognosis group and poor prognosis group according to the presence or absence of the brain death due to irreversible damages.Ischemic side carotid wall parameters of two subgroups were analyzed,and their predictive value for disease prognosis and correlation with the National Institutes of Health Stroke Scale(NIHSS) were also explored.The control group was followed up for two years,and further divided into disease group and normal group according to the presence or absence of ischemic stroke.Carotid artery wall parameters and their predictive value were analyzed in both groups.Results:The lumen area of the ischemic side was smaller than that of non-ischemic side,and the total vessel area,wall area and mean normalized wall index were larger than those of non-ischemic side(P<0.05).The lumen area of good prognosis group was larger than that of poor prognosis group,and the total vessel area,wall area and mean normalized wall index were smaller than those of poor prognosis group(P<0.05).The area under the receiver operating characteristic curve(AUC) of the combined test of carotid wall parameters for prognosis prediction in ischemic stroke patients was the largest AUC(0.824).The lumen area was negatively correlated with NIHSS in study group(P<0.05).The lumen area of the disease group was smaller than that of normal group,and the total vessel area,wall area and mean normalized wall index were larger than those of normal group(P<0.05).The AUC of the combined test of carotid wall parameters for disease onset prediction in asymptomatic risk individuals was the largest AUC(0.838).Conclusion:Carotid artery wall parameters are of great value in detecting the prognosis of ischemic stroke and the incidence of ischemic stroke in asymptomatic risk population.Furthermore,patients with larger the lumen area suffer a more severe neurological injury.