颈动脉粥样硬化斑块强化与脑血管症状相关性的MDCT研究  

Enhancement of Carotid Atherosclerotic Plaque Using Multi Detector CT Angiography: Correlation of Cerebrovascular Symptoms

作　　者：国晶晶[1] 田超[1] 宋一鸣[1] 杨天昊[1] 靳松[1] 

机构地区：[1]天津市环湖医院神经放射科,300060

出　　处：《临床放射学杂志》2013年第12期1698-1701,共4页Journal of Clinical Radiology

摘　　要：目的通过颈动脉多排螺旋CT血管造影(MDCTA)分析颈动脉粥样硬化斑块的强化程度和特征及其与脑血管症状的关系。方法 958例行颈动脉MDCTA的连续患者中符合纳入标准者372例,并分为有症状组和无症状组。MDCTA前首先以相同扫描条件进行平扫,分别在平扫和MDCTA图像上测量非钙化性和混合性斑块的CT值,计算斑块CT值增幅;同时测量颈动脉狭窄程度。统计学分析采用χ2检验、t检验、受试者工作特征曲线分析和多因素Logistic回归分析。结果 372例中,80.11%(298/372)的患者颈动脉斑块出现强化。非钙化性斑块的强化程度高于混合性斑块的非钙化部分[(25.11±4.53)HU vs(17.92±7.12)HU;t=12.94,P=0.004],且几率也大(86.26%,182/211 vs 72.05%,68/116;χ2=11.57,P=0.001)。有症状组出现颈动脉斑块强化的比例大于无症状组(88.41%,206/233 vs 66.19%,92/139;χ2=26.99,P=0.000)。受试者工作特征曲线阈值分析表明斑块CT值增幅17 HU为最佳阈值,具有较高敏感性和特异性(78.97%、81.30%)。颈动脉斑块强化(P=0.016)、非钙化性斑块(P=0.042)及颈动脉管腔重度狭窄(P=0.032)与脑血管症状之间的相关性均具有显著统计学意义。结论颈动脉粥样硬化斑块强化与脑血管症状有关,是预测脑血管事件的独立因素,具有重要临床意义。Objective To analyze the relationship between the enhancement characteristics of carotid atherosclerotic plaque and cerebrovascular symptoms by multidetector CT angiography （MDCTA）. Methods 372 patients meeting the criterion were enrolled into this study from 958 continuous patients accepted MDCTA. They were divided into two groups： symptomatic group and asymptomatic group. The data of plain CT and MDCTA were both acquired with the same parame ters. The CT attenuations of carotid non calcified and mixed atheroselerotic plaques were measured, and the differences of CT attenuation between them were calculated. The degree of carotid artery stenosis was also evaluated. The statistics meth ods were X2 test, t test, ROC curve analysis, and multiple logistic regression analysis. Results 372 patients were includ ed, and 80. 11% （298/372） of carotid plaques showed enhancement. Both enhancement degree and ratio of noncalcified plaques were higher than those of noncalcified portion of mixed plaques （25.11± 4.53 ） HU vs（ 17.92 ± 7.12 ） HU; t = 12.94, P = 0. 0041 （86 26%, 182/211 vs 72.05% , 68/116 ; X2 = 11.57, P = 0. 001 ）. The ratio of plaque enhancement in symptomatic group was higher than that in asymptomatic group （88.41%, 206/233 vs 66.19% , 92/139;X2 = 26.99 ,P =0.000）. ROC curve analysis revealed that the optimal threshold of plaque enhancement was 17 HU with sensitivity and specificity of 78.97% and 81.30%. The correlations among cerebrovaseular symptom and carotid plaque enhancement （P =0.016）, noncalcified plaque （P =0.042）, and severe carotid stenosis （P =0. 032） were significant. Conclusion The enhancement of carotid plaque is associated with eerebrovaseular symptoms, and is an independent predictors of cere brovascular symptoms.

关 键 词：颈动脉粥样硬化斑块体层摄影术 X线计算机强化脑血管症状 

分 类 号：R445.1[医药卫生—影像医学与核医学]