MR高分辨血管壁成像对椎-基底动脉延长扩张症患者管壁易损斑块的诊断价值  

Diagnostic value of MR high⁃resolution vessel wall imaging for vulnerable plaques in the wall of patients with vertebrobasilar artery prolonged dilatation

作　　者：刘兵[1] 康志雷[1] 王心颖 管铁岗[1] 耿姿慧 LIU Bing;KANG Zhilei;WANG Xinying(Center of Image,Halison International Peace Hospital Imaging Center,Hengshui 053000,China)

机构地区：[1]哈励逊国际和平医院影像中心,衡水053000 [2]哈励逊国际和平医院神经内科,衡水053000 [3]衡水市第四人民医院影像中心

出　　处：《临床神经病学杂志》2023年第4期257-261,共5页Journal of Clinical Neurology

基　　金：河北省医学科学研究课题计划(20220470)。

摘　　要：目的探究MR高分辨血管壁成像(HRMR-VWI)对椎-基底动脉延长扩张症(VBD)患者管壁易损斑块的诊断价值。方法选取114例经DSA确诊存在管壁斑块的VBD患者。行HRMR-VWI检查,记录管壁斑块分布情况、斑块易损性及斑块特征。比较稳定斑块组和易损斑块组一般资料、HRMR-VWI测量的基底动脉(BA)直径、BA分叉高度、BA曲折程度,分析HRMR-VWI诊断VBD管壁斑块位置、斑块易损性的准确度,分析BA直径、BA分叉高度、BA曲折程度与管壁斑块易损性的相关性。结果存在管壁斑块的VBD患者管壁斑块分布以背侧壁为主(57.74%),其次为前壁(14.88%)、右壁(11.90%)、左壁(10.12%)、环壁(5.36%)。易损斑块特征以斑块内出血为主(46.15%),其次为纤维帽断裂(28.21%)、大脂质核心(25.64%)。与稳定斑块组比较,易损斑块组BA直径显著升高(t=4.342,P<0.001),BA分叉高、BA曲折程度差异有统计学意义(χ^(2)=6.039,P=0.014;χ^(2)=5.639,P=0.018);HRMR-VWI诊断VBD管壁斑块位置、斑块易损性的准确度均为100%。VBD患者BA直径、BA分叉高度、BA曲折程度均与管壁斑块易损性密切相关(OR=3.026,P<0.001;OR=4.165,P<0.001;OR=3.575,P<0.001)。结论HRMR-VWI能准确判断VBD患者管壁斑块位置、斑块易损性,且BA直径、BA分叉高度、BA曲折程度均与管壁斑块易损性有关。HRMR-VWI检查可准确评估患者上述指标,为临床判断斑块易损性提供科学依据。Objective To investigate the diagnostic value of MR high⁃resolution vessel wall imaging(HRMR⁃VWI)for vulnerable plaques in the wall of patients with vertebral basilar artery prolonged dilatation(VBD).Methods A total of 114 patients with VBD confirmed by DSA were selected.HRMR⁃VWI was performed to record the distribution of plaque,plaque vulnerability and plaque characteristics.The general data,basilar artery(BA)diameter,BA bifurcation height and BA tortuosity measured by HRMR⁃VWI were compared between the stable plaque group and vulnerable plaque group.The accuracy of HRMR⁃VWI in diagnosing the location of plaque in the canal wall of VBD and plaque vulnerability was analyzed.The correlation between BA diameter,BA bifurcation height and BA tortuosity and canal wall plaque vulnerability was analyzed.Results The distribution of tubular wall plaques in VBD patients with the presence of tubular wall plaques was a predominantly dorsal wall(57.74%),followed by the anterior wall(14.88%),right wall(11.90%),left wall(10.12%)and circumferential wall(5.36%).The vulnerable plaque characteristics were dominated by intraplaque hemorrhage(46.15%),followed by fibrous cap breakage(28.21%),and large lipid core(25.64%).Compared with those in stable plaque group,BA diameter in vulnerable plaque group were significantly higher(t=4.342,P<0.001),and the differences of BA bifurcation height and BA curvature were statistically significant(χ^(2)=6.039,P=0.014;χ^(2)=5.639,P=0.018).The accuracy of HRMR⁃VWI in diagnosing the location of tubular wall plaques and plaque vulnerability in VBD was 100%.The BA diameter,BA bifurcation height,and BA tortuosity in patients with VBD were closely correlated with tubular wall plaque vulnerability(OR=3.026,P<0.001;OR=4.165,P<0.001;OR=3.575,P<0.001).Conclusions HRMR⁃VWI can accurately determine the location of the plaque and plaque vulnerability in patients with VBD,and BA diameter,BA bifurcation height and BA curvature degree are all related to plaque vulnerability in the canal wall.HRMR�

关 键 词：椎-基底动脉延长扩张症 MR高分辨血管壁成像 管壁斑块 斑块易损性 

分 类 号：R743[医药卫生—神经病学与精神病学]