3．0T高分辨率磁共振评价冠状动脉粥样硬化患者的颈动脉斑块特征  

Carotid plaque characteristics detected with 3. 0T high resolution nuclear magnetic resonance imaging in patients with coronary artery disease

作　　者：宋昌鹏[1] 王德昭[1] 胡宏宇[1] 付强[1] 陈威[1] 王茜[1] 郭彩霞[1] 田俊萍[1] 马力[1] 徐晓薇[1] 隋滨滨[2] 金鹤[2] 陈步星[1] 

机构地区：[1]首都医科大学附属北京天坛医院心内科,100050 [2]首都医科大学附属北京天坛医院放射科,100050

出　　处：《中华心血管病杂志》2016年第1期38-42,共5页Chinese Journal of Cardiology

摘　　要：目的采用3．0T高分辨率磁共振评价冠状动脉粥样硬化患者颈动脉斑块的特征。方法采用前瞻性研究方法，连续入选2013年1月至2015年1月在jE京天坛医院行冠状动脉造影显示动脉粥样硬化并行颈动脉3．0T高分辨率磁共振检查的患者104例，剔除磁共振图像质量差的患者后，最终纳入患者97例。根据冠状动脉狭窄程度，将患者分成3组：动脉粥样硬化组（冠状动脉存在粥样硬化病变，且冠状动脉管腔狭窄程度〈50％），共16例；单支病变组（1支冠状动脉的管腔狭窄程度≥50％），共48例；多支病变组（2或3支冠状动脉的管腔狭窄程度≥50％或左主干病变），共33例。比较3组患者3．0T高分辨率磁共振影像中的颈动脉斑块特征，包括钙化、富含脂质坏死核心、斑块内出血、斑块溃疡和破裂。结果3．0T高分辨率磁共振检查显示：动脉粥样硬化组、单支病变组和多支病变组之间的颈动脉斑块[分别为81．3％（13／16）、72．9％（35／48）和93．9％（31／33）]和钙化斑块[分别为50．0％（8／16）、35．4％（17／48）和42．4％（14／33）]检出率差异均无统计学意义（P均〉0．05）；动脉粥样硬化组患者颈动脉斑块内富含脂质坏死核心的检出率低于单支病变组和多支病变组[分别为18．8％（3／16）、64．6％（31／48）和69．7％（23／33），P均〈0．01]，而单支病变组与多支病变组之间的脂质坏死核心检出率差异无统计学意义（P〉0．05）；多支病变组中2例患者（6．1％）检出颈动脉斑块内出血，其余2组均未见斑块内出血；3组患者的颈动脉均未见斑块溃疡和破裂。结论颈动脉斑块特征可能与冠状动脉粥样硬化的严重程度有关。Objective To assess the value of detecting the compositional features of carotid atherosclerotic plaques by 3.0T high resolution magnetic resonance imaging （MRI） in patients with coronary artery disease （CAD）. Methods Consecutive 104 patients with coronary atherosclerosis confirmed by coronary angiography were prospectively recruited from January 2013 to January 2015 in Tiantan hospital. All patients were imaged with 3.0T high resolution MRI system. After exclusion patients with poor image quality, 97 patients were divided into 3 groups according to the degree of coronary artery stenosis ： coronary atherosclerosis group （coronary stenosis between 1% -49%, n=16）; single-vessel lesion group （single vessel lesion with stenosis between 50% - 100%, n = 48） ; multi-vessel lesion group （two or three vessel lesions with stenosis between 50% - 100% or left main stem disease, n = 33 ）. The prevalence of total carotid plaque, calcified plaque, lipid-rich necrotic core, intra-plaque hemorrhage, plaque ulcer and rupture were compared among 3 groups. Results The prevalence of total carotid plaque （81.3 % （13/16） ,72. 9% （35/48） ,and 93.9% （ 31/33 ） ） and calcified plaque （ 50.0% （ 8/16 ）, 35.4% （ 17/48 ）, and 42.4% （ 14/33 ） ） were similar among the 3 groups （both P 〉 0.05）. The prevalence of carotid lipid-rich necrotic core in coronary atherosclerosis group was significantly lower than in single-vessel lesion group （18.8% （3/16） vs. 64. 6% （ 31/48 ）, P 〈 0. 01 ） and multi-vessel lesion group （ 18.8% （3/16） vs. 69. 7% （23/33） ,P 〈 0. 01 ）, but there was no significant difference between single-vessel lesion group and multi-vessel lesion group （ P 〉 0. 05 ）. Intra-plaque hemorrhage was detected in 2 patients of nmlti-vessel lesion group. There was no plaque ulcer or rupture in this cohort. Conclusion Carotid plaque features are associated with the severity of coronary atherosclerosis in CAD oatients.

关 键 词：冠状动脉疾病 颈动脉狭窄 磁共振波谱学 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.3[医药卫生—诊断学]