基于高分辨率血管壁MRI评估药物涂层球囊治疗颅内动脉粥样硬化性狭窄的价值  

Evaluation value of drug balloon therapy for intracranial atherosclerotic stenosis based on high-resolution vascular wall MRI

作　　者：陈坤健 王新怡[1] 毛慧敏 郭宇 王心雨 张超 Chen Kunjian;Wang Xinyi;Mao Huimin;Guo Yu;Wang Xinyu;Zhang Chao(Department of Radiology,the First Affiliated Hospital of Shandong First Medical University&Shangdong Provincial Qianfoshan Hospital,Jinan 250014,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)放射科,济南250014

出　　处：《中华放射学杂志》2022年第11期1202-1208,共7页Chinese Journal of Radiology

基　　金：山东省科技发展计划项目(2009GG10002024)。

摘　　要：目的探讨高分辨率血管壁MRI(VW-MRI)评估药物涂层球囊治疗颅内动脉粥样硬化性狭窄的价值。方法回顾性分析2019年9月至2021年7月山东第一医科大学第一附属医院收治的21例症状性颅内动脉粥样硬化性狭窄患者的资料, 年龄22~73(49±15)岁, 其中男15例, 女6例。所有患者均接受SeQuent Please药物涂层球囊再通治疗并在术前1周及治疗后2~3个月接受数字减影血管造影(DSA)、常规MRI及VW-MRI。评估血管内治疗前后粥样硬化斑块的面积、长度、强化幅度及管腔狭窄率的变化。治疗前后的比较采用配对t检验或Wilcoxon符号秩检验, 以受试者操作特征(ROC)曲线分析各斑块特征预测术后疗效的价值;用Pearson相关分析和Bland-Altman法对VW-MRI与DSA测量管腔狭窄率的相关性和一致性进行分析。结果 VW-MRI显示药物涂层球囊血管内治疗后斑块的面积[(1.86±1.28)mm2]、长度[3(2, 4)mm]、强化幅度[(60±20)%]及管腔狭窄率[(28±16)%]均小于治疗前[分别为(5.97±1.15)mm^(2), t=10.93, P<0.001;7(6, 9)mm, Z=-3.94, P<0.001;(107±46)%, t=4.26, P<0.001;(89±5)%, t=17.27, P<0.001]。斑块的面积、长度、强化幅度对评估血管内治疗效果具有一定价值(曲线下面积分别为0.89、0.86、0.74)。血管内治疗前后VW-MRI和DSA对管腔狭窄率的测量呈正相关(r治疗前=0.66, P<0.001;r治疗后=0.96, P<0.001), 并具有一致性。结论 VW-MRI可以从粥样硬化斑块基本特征及管腔狭窄程度的变化评估药物涂层球囊血管内治疗的有效性, 是一种较好的影像学随访手段。Objective To explore the value of high resolution vascular wall MRI(VW-MRI)in drug balloon therapy of intracranial atherosclerotic stenosis.Methods A total of 21 patients with intracranial atherosclerotic stenosis admitted to the First Affiliated Hospital of Shandong First Medical University from September 2019 to July 2021 were retrospectively analyzed,aged 22-73(49±15)years,including 15 males and 6 females.All patients were treated with SeQuent Please drug coated balloon recanalization,and performed digital subtraction angiography(DSA),routine MRI and VW-MRI examinations within one week before operation and 2 to 3 months after treatment.The changes of atherosclerotic plaque area,length,enhancement index and stenosis degree before and after recanalization were evaluated.Paired t-test or Wilcoxon test was separately used to compare the difference before and after operation.The value of plaque characteristics in evaluating postoperative efficacy was analyzed by the receiver operating characteristic(ROC)curve.Pearson correlation analysis and Bland-Altman images method were used to test the correlation and consistency of VW-MRI and DSA in measuring the lumen stenosis degree.Results After endovascular treatment with drug-coated balloon,the plaque area[(1.86±1.28)mm2],length[3(2,4)mm],enhancement index[(60±20)%]and lumen stenosis degree[(28±16)%]were significantly lower than those before endovascular treatment[(5.97±1.15)mm2,t=10.93,P<0.001;7(6,9)mm,Z=-3.94,P<0.001;(107±46)%,t=4.26,P<0.001;(89±5)%,t=17.27,P<0.001].The plaque area,length and enhancement index showed diagnostic value for evaluating the endovascular treatment efficacy(area under the ROC curve=0.89,0.86,0.74,respectively).Stenosis degree measured by VW-MRI had a positive correlation(rpreoperative=0.66,P<0.001;rpostoperative=0.96,P<0.001)and consistency with DSA before and after recanalization.Conclusion VW-MRI can be used to comprehensively and effectively evaluate treatment effect after endovascular treatment from the changes of plaque basic chara

关 键 词：卒中 动脉粥样硬化 磁共振成像 

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