短暂性脑缺血发作患者的高分辨力MRI特征及其与ABCD3评分相关性的研究  

High-resolution MRI feature of transient ischemic attack patients and its correlation with ABCD3 score

作　　者：周忠凯 石莹 钟镝[2] 任艺博 孙佳莉 陈悦 邹文轩 隋莹 王巍[1] ZHOU Zhongkai;SHI Ying;ZHONG Di;REN Yibo;SUN Jiali;CHEN Yue;ZOU Wenxuan;SUI Ying;WANG Wei(Department of Magnetic Resonance,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Neurology,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院磁共振科,哈尔滨150001 [2]哈尔滨医科大学附属第一医院神经内科,哈尔滨150001

出　　处：《磁共振成像》2022年第10期91-97,共7页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的利用高分辨力磁共振成像(high-resolution magnetic resonance imaging,HR-MRI)探究短暂性脑缺血发作(transient ischemic attack,TIA)患者低中危组与高危组间斑块特征的差异及ABCD3评分与斑块特征的相关性。材料与方法回顾性分析72例接受HR-MRI检查的TIA患者病例。根据风险评分量表ABCD3分为低中危组(ABCD3<6)与高危组(ABCD3≥6)。两名有五年以上斑块分析经验的医师独立识别出斑块位置、斑块成分,测量并计算斑块或参考管腔的血管面积和管腔面积、狭窄率、标准化壁指数(normalized wall index,NWI)、重构指数(remodeling index,RI)。依照对比后增强率(enhancement ratio,ER)定量对斑块强化进行分级:0级(ER_(斑块)≤ER_(参考管壁)),1级(ER_(参考管壁)<ER_(斑块)<ER_(垂体漏斗))和2级(ER斑块≥ER垂体漏斗)。采用t检验、Mann-Whitney U检验或卡方检验比较组间临床特征和斑块特征的差异。斑块特征和ABCD3评分的相关性通过Spearman等级相关或Pearson相关进行分析。结果72名患者最终纳入研究,高危组(n=39,54.17%)的NWI、RI数值显著高于低中危组(n=33,45.83%)[0.86(0.76,0.92)vs.0.62(0.49,0.75);1.25(1.05,1.33)vs.1.00(0.81,1.11);P均<0.05],高危组的斑块内出血(intraplaque hemorrhage,IPH)和2级强化比例显著高于低中危组[74.4%vs.33.3%;56.4%vs.6.1%;P均<0.05],且NWI(r=0.661,P<0.01)、IPH(r=0.388,P<0.01)、斑块强化(r=0.467,P<0.01)与ABCD3评分呈正相关。结论本研究揭示了低中危组及高危组TIA患者的颅内动脉粥样硬化斑块的不同形态学特征,且NWI、IPH和2级强化是识别高风险TIA患者的潜在指标,HR-MRI探测这些特征可为TIA患者的早期干预提供循证医学证据。Objective:To investigate the differences in plaque characteristics between different ABCD3 scores and the correlation between ABCD3 scores and plaque characteristics in patients with transient ischemic attack(TIA)based on high-resolution MRI(HR-MRI).Materials and Methods:Seventy-two patients underwent HR-MRI with TIA were retrospectively analyzed,which were divided into a low-intermediate risk group(ABCD3 score<6)and a high-risk group(ABCD3 score≥6).Two experienced radiologists independently identified plaque characteristics.Vascular area and lumen area,stenosis rate,normalized wall index(NWI),and remodeling index(RI)of the plaque or reference lumen were measured and calculated.Plaque enhancement was quantified according to the enhancement ratio(ER)after contrast:grade 0(ER_(plaque)≤ER_(reference vessel) wall),grade 1(ER_(reference vessel_ wall<ER_(plaque)<ER_(pituitary infundibulum))and grade 2(ER_(plaque)≥ER_(pituitary infundibulum)).Differences of clinical and plaque characteristics between groups were compared using t-test,Mann-Whitney U test,or chi-square test.Correlations between plaque characteristics and ABCD3 scores were analyzed by Spearman rank correlation or Pearson correlation.Results:Seventy-two patients underwent HR-MRI with TIA were retrospectively analyzed,the NWI and RI in the high-risk group(n=39,54.17%)were significantly higher than those in the low-to-intermediate-risk group(n=33,45.83%)[0.86(0.76,0.92)vs.0.62(0.49,0.75);1.25(1.05,1.33)vs.1.00(0.81,1.11);P<0.05].The proportion of intraplaque hemorrhage(IPH)and grade 2 enhancement was significantly higher in the high-risk group than in the low-to-intermediate-risk group[74.4%vs.33.3%;56.4%vs.6.1%;P<0.05].The NWI(r=0.661,P<0.01),IPH(r=0.388,P<0.01),and plaque enhancement(r=0.467,P<0.01)were positively correlated with the ABCD3 score.Conclusions:This study revealed different morphological characteristics of intracranial atherosclerotic plaques in patients with low-to-medium-risk and high-risk TIA.NWI,IPH and grade 2 enhancement are potenti

关 键 词：短暂性脑缺血发作 ABCD3评分 动脉粥样硬化 斑块 早期诊断 高分辨力磁共振成像 磁共振血管成像 扩散加权成像 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R743.31[医药卫生—诊断学]