国人基于MRI颈动脉狭窄预警易损斑块的效能研究  

Efficacy of Warning of Vulnerable Plaque in Chinese Population Based on MRI Carotid Stenosis

作　　者：董莉[1] 于薇[1] 王振常[2] 王艳阳[3] 陆东旭[1] 赵轶轲[1] 张兆琪[1] DONG Li;YU Wei;WANG Zhenchang;WANG Yanyang;LU Dongxu;ZHAO Yike;ZHANG Zhaoqi(Department of Radiology,Capital Medical University,Beijing Youyi Hospital,Beijing 100050,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院医学影像科,北京100029 [2]首都医科大学附属北京友谊医院放射科,北京100050 [3]首都医科大学附属北京安贞医院血管外科,北京100029

出　　处：《中国医学影像学杂志》2019年第10期736-739,744,共5页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金面上项目（81171335）;北京市自然科学基金-海淀联合创新基金（17L20194）

摘　　要：目的探讨高分辨MRI颈动脉狭窄程度与易损斑块的相关性,判断其识别易损斑块的能力。资料与方法66例患者行双侧颈动脉MRI检查,包括常规增强血管造影和高分辨斑块MRI。测量管腔狭窄程度,定性分析斑块成分,判断斑块的稳定性。结果血管狭窄程度与易损斑块内出血、纤维帽破裂呈正相关(r=0.25,P=0.007;r=0.36,P=0.001)。受试者工作特征(ROC)曲线分析显示,管腔狭窄程度预测斑块内出血及纤维帽破裂的准确性均较低(斑块内出血ROC曲线下面积0.74,95%CI 0.52~0.96,P=0.10;纤维帽破裂ROC曲线下面积0.65,95%CI 0.43~0.88,P=0.20)。即使在颈动脉管腔无狭窄的血管壁上,仍有8.7%出现斑块内出血,4.3%出现纤维帽破裂。结论单纯评判血管狭窄程度不足以判断斑块的稳定性,需结合血管狭窄程度及斑块的易损成分综合评估患者的危险性。Purpose To investigate the correlation of high resolution MRI carotid artery stenosis degree to vulnerable plaque.Materials and Methods Sixty-six patients underwent bilateral carotid arteries MRI examination,including conventional enhanced magnetic resonance angiography and high-resolution plaque MRI.The degree of lumen stenosis was measured,plaque composition was analyzed qualitatively,and stability of plaque was judged.Results Hemadostenosis degree was positively correlated to intraplaque hemorrhage(IPH)and fibrous cap rupture(FCR)(r=0.25,P=0.007;r=0.36,P=0.001).The receiver operating characteristic(ROC)curve analysis showed that the accuracy of degree of lumen stenosis in prediction of IPH and FCR was lower(IPH:area under the ROC curve was 0.74,95%CI 0.52-0.96,P=0.10;FCR:area under the ROC curve was 0.65,95%CI 0.43-0.88,P=0.20).Even on the vascular wall of carotid lumen without stenosis,intraplaque hemorrhage occurred in 8.7%,and fibrous cap rupture in 4.3%.Conclusion It is not sufficient to judge the stability of plaque by simply judging the degree of vascular stenosis,and the risk of patients should be assessed comprehensively in combination with the degree of vascular stenosis and the vulnerable components of plaque.

关 键 词：颈动脉狭窄 磁共振成像 斑块 动脉粥样硬化 磁共振血管造影术 

分 类 号：R543.4[医药卫生—心血管疾病] R445.2[医药卫生—内科学]