首发和复发急性缺血性脑卒中患者颈动脉斑块的磁共振成像对比研究  

High-resolution black-blood MRI findings of carotid atherosclerotic plaque in initial and recurrent acute ischemic stroke: a comparison study

作　　者：方淳[1] 刘晓晟[2] 孙文萍[3] 刘传森[1] 肖亚平[1] 

机构地区：[1]上海同济大学附属东方医院介入科,200120 [2]上海交通大学医学院附属仁济医院放射科 [3]上海交通大学附属第六人民医院介入影像科

出　　处：《介入放射学杂志》2014年第3期191-194,共4页Journal of Interventional Radiology

基　　金：上海市科研计划项目资助课题(1411953600)

摘　　要：目的利用磁共振成像(MRI)技术比较首发和复发急性缺血性脑卒中患者颈动脉粥样硬化斑块的特征。方法 2009年8月—2010年11月对89例近期急性缺血性脑卒中患者行颈动脉高分辨MRI黑血成像,其中51例为首发,38例为复发。对脑卒中同侧的责任颈动脉进行分析,对比初发及复发性缺血性脑卒中患者动脉斑块负荷及成分的差别。结果与初发患者相比,复发患者的平均壁面积(WA)、壁厚度(WT)及平均壁体积(PWV)较大,组间差异有统计学意义(P<0.05);钙化比例高(44.7%比23.5%,P=0.035),脂质坏死核心(LRNC)更丰富[(179.14±254.81)mm3比(71.65±111.15)mm3,P=0.027]。在复发患者与首发患者中,斑块内出血(IPH)、纤维帽破裂或者两者都发生的比例分别为15.8%和3.9%。结论复发患者颈动脉斑块较初发患者有显著进展,利用MRI监测初发患者的斑块情况有利于防治脑卒中的再次发生。Objective To investigate MR imaging characteristics of carotid plaque in patients with first-time and recurrent acute ischemic stroke. Methods During the period from Aug. 2009 to Nov. 2010, high-resolution black-blood MR scanning of carotid was carried out in 89 patients with recently-developed acute ischemic stroke, which included initial attack （n = 51） and recurrent attack （n = 38）. The ipsilateral responsible carotid arteries were quantitatively and qualitatively analyzed. The carotid plaque burden and compositional features were compared between the initial and recurrent stroke patients. Results Of the 89 patients, 51 had first-time stroke and 38 had recurrent stroke. The mean WA, WT and PWV were greater in patients with recurrent stroke than those in patients with first-time stroke （P 〈 0.05）. Compared with the firsttime stroke patients, the recurrent stroke patients had significantly higher prevalence of calcification （44.7% versus 23.5%, P = 0.035） and larger volume of LRNC as well （179.14 ± 254.81 mm2 versus 71.65 ± 111.15 mm2, P = 0.027）. IPH and/or fibrous cap rupture were observed in 15.8% of patients with recurrent stroke and only 3.9% of patients with first- time stroke. Conclusion Carotid plaques in patients with recurrent ischemic stroke are significantly worse than those in patients with first-time stroke. Monitoring the carotid plaques in patients with initial stroke by MR scanning may be helpful for the prevention of recurrent stroke.

关 键 词：颈动脉斑块 急性缺血性脑卒中 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学]