颈动脉斑块内出血与斑块位置的高分辨率磁共振成像研究  

Study on intraplaque hemorrhage and location of carotid plaques by high-resolution magnetic resonance imaging

作　　者：张波 杨晋名 杨嬗 唐烨 潘磊 冯喆 曹鑫 耿道颖 张军[3] ZHANG Bo;YANG Jinming;YANG Shan;TANG Ye;PAN Lei;FENG Zhe;CAO Xin;GENG Daoying;ZHANG Jun(Department of Radiology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院放射科,上海200040 [2]上海脑重大疾病智能影像工程技术研究中心 [3]复旦大学医学功能与分子影像研究所

出　　处：《上海医学》2021年第4期221-226,共6页Shanghai Medical Journal

基　　金：上海市科学技术委员会科研计划项目(19411951200)。

摘　　要：目的应用三维(3D)高分辨率磁共振成像(HR-MRI)分析颈动脉斑块内出血(IPH)的发生与斑块位置的关系,探讨斑块所处位置可能引起IPH的潜在机制。方法收集2019年4月—2020年1月在复旦大学附属华山医院神经内科就诊的92例缺血性脑卒中患者的临床资料,影像学资料从放射科影像归档和通信系统(PACS)中提取。应用ITK-SNAP软件3.6.0对原始图像进行横断面和矢状面多平面重建(MPR)。根据斑块在同步非增强血管造影和IPH(SNAP)成像序列的MRI信号特点判断有无IPH,记录斑块位置所处象限;观察增强前后的斑块信号差异,判断增强的程度。结果最后共66例患者纳入研究,其中52例患者双侧颈动脉各有1枚斑块,14例患者仅单侧有1枚斑块,共计118枚斑块。有IPH斑块28枚,IPH体积/斑块体积的比值为0.23±0.16,斑块强化率达100%(28/28);无IPH的斑块90枚,斑块强化率为62.22%(56/90);有IPH斑块的强化率显著高于无IPH斑块(P<0.05)。无IPH斑块的分布:第Ⅰ象限6个(6.67%),第Ⅱ象限28个(31.11%),第Ⅲ象限16个(17.78%),第Ⅳ象限40个(44.44%)。有IPH斑块的分布:第Ⅰ象限6个(21.43%),第Ⅱ象限8个(28.57%),第Ⅲ象限0个,第Ⅳ象限14个(50.00%)。有IPH斑块在第Ⅰ象限内所占比例显著高于无IPH斑块(P<0.05),而在第Ⅲ象限内所占比例显著低于无IPH斑块(P<0.05)。结论颈动脉斑块的位置可能会影响IPH的发生,IPH与斑块强化间存在一定联系。Objective To investigate the relationship between the occurrence of intraplaque hemorrhage(IPH)and the location of carotid atherosclerotic plaques using three dimensional(3D)high-resolution magnetic resonance imaging(HR-MRI).Methods Ninety-two patients with ischemic stroke admitted to our hospital between April 2019 and January 2020 were collected.Their imaging data were extracted from picture archiving and communication system(PACS).Multi-planner reconstruction(MPR)of axial and sagittal images was conducted by ITK-SNAP software 3.6.0.IPH was observed by MRI signal characteristics of plaque in simultaneous non-contrast angiography and intraplaque hemorrhage(SNAP),and the quadrant of plaque distribution was recorded.The degree of enhancement was judged by observing the signal difference before and after plaque enhancement.Results Finally,a total of 66 patients were included in the study,of whom 52 patients had one plaque in each side of the carotid artery,and 14 patients had only one plaque.In 28 plaques with IPH,the ratio of IPH/plaque volume was 0.23±0.16,and the plaque enhancement rate was 100%(28/28).In 90 plaques without IPH,the plaque enhancement rate was 62.22%(56/90).The enhancement rate of plaques with IPH was significantly higher than that without IPH(P<0.05).The distribution of plaque without IPH was as follows:6(6.67%)in the first quadrant,28(31.11%)in the second quadrant,16(17.78%)in the third quadrant and 40(44.44%)in the fourth quadrant.The distribution of plaque with IPH:6(21.43%)in the first quadrant,8(28.57%)in the second quadrant,0 in the third quadrant,and 14(50.00%)in the fourth quadrant.The proportion of plaque with IPH in the first quadrant was significantly higher than that without IPH(P<0.05),and the proportion of plaque with IPH in the third quadrant was significantly lower than that without IPH(P<0.05).Conclusion The location of carotid plaque may influence the occurrence of IPH,and there is a certain correlation between IPH and plaque enhancement.

关 键 词：颈动脉斑块 斑块内出血 高分辨率磁共振成像 壁切应力 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]