颈动脉斑块MRI特征与同侧急性脑梗死患者DWIGASPECTS的相关性研究  

Correlation of carotid plaque characteristics with DWI-ASPECTS score in ipsilateral acute cerebral infarction patients

作　　者：王贝茹 余苗 徐彤彤 李均彪 胡春峰 WANG Bei-ru;YU Miao;XU Tong-tong(Department of Medical Imaging,the Affiliated Hospital of Xuzhou Medical University,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院影像科,江苏221000 [2]徐州医科大学附属医院介入科,江苏221000

出　　处：《放射学实践》2024年第1期49-54,共6页Radiologic Practice

摘　　要：目的:探讨颈动脉斑块MRI特征与同侧急性脑梗死患者DWI-ASPECTS的相关性。方法:回顾性搜集我院85例颈动脉斑块患者的临床及影像资料,所有患者均于出现脑血管症状2周内行颈动脉高分辨率MRI和常规颅脑MRI平扫。将患者分为DWI-ASPECTS≤7分组和DWI-ASPECTS>7分组,比较两组间临床、实验室资料和颈动脉斑块定量、定性指标的差异。通过Logistic回归筛选DWI-ASPECTS评分的预测因子。结果:25例(29.4%)DWI-ASPECTS≤7分,60例(70.6%)DWI-ASPECTS>7分。DWI-ASPECTS≤7分组患者纤维帽变薄/破裂(分别为80.0%和35.0%,P<0.001)、斑块内出血(分别为72.0%和21.7%,P<0.001)、钙化(分别为76.0%和45.0%,P=0.009)和富脂质坏死核心(分别为72.0%和45.0%,P=0.023)的发生率均高于DWI-ASPECTS>7分组;此外,DWI-ASPECTS≤7分组患者显示出更高的斑块负荷,DWI-ASPECTS≤7分组与DWI-ASPECTS>7分组的最大管壁厚度[分别为(4.38±1.68)和(3.47±1.78)mm,P=0.033]、平均管腔面积[分别为(15.33±11.57)和(22.88±13.95)mm 2,P=0.019]、最小管腔面积[分别为(11.52±11.23)和(18.98±13.52)mm 2,P=0.017]、平均管壁面积[分别为(62.81±14.32)、(55.66±14.93)mm 2,P=0.045]、最大管壁面积[分别为(66.70±14.57)、(59.56±15.19)mm 2,P=0.049]、平均标准化管壁面指数[分别为(81±14)%、(71±16)%,P=0.011]、最大标准化管壁指数[分别为(86±14)%、(76±16)%,P=0.012)]差异均有统计学意义。DWI-ASPECTS≤7分组中NIHSS评分>4分的患者比例更高(分别为48%和23.3%,P=0.025),高密度脂蛋白浓度更低[分别为(1.24±0.28)、(1.10±0.28)mmol/L,P=0.043]。Logistic回归分析结果显示,纤维帽变薄/破裂(OR=4.133,95%CI:1.151~14.836,P=0.030)和斑块内出血(OR=6.409,95%CI:1.737~23.646,P=0.005)与较低的DWI-ASPECTS评分显著相关。结论:颈动脉斑块中存在纤维帽变薄/破裂和斑块内出血的急性脑卒中患者DWI-ASPECTS评分更低,有助于评估患者的病情严重程度。Objective:To analyze the correlation between carotid plaque characteristics and DWI-ASPECTS score in patients with ipsilateral acute cerebral infarction.Methods:The clinical and imaging data of 85 patients with carotid plaque in our hospital were retrospectively analyzed.All patients underwent carotid high resolution MRI and conventional brain MR plain scan within 2 weeks after the onset of cerebrovascular symptoms.Patients were divided into DWI-ASPECTS≤7 and DWI-ASPECTS>7 groups.The clinical,laboratory,and the quantitative and qualitative parameters of the carotid plaque were compared between groups.The predictors of DWI-ASPECTS score were screened by Logistic regression.Results:Of the 85 patients,25(29.4%)was DWI-ASPECTS≤7 and 60(70.6%)was DWI-ASPECTS>7.Compared with DWI-ASPECTS>7 group,incidence of TRFC(80%vs 35%,P<0.001),IPH(72%vs 21.7%,P<0.001),CA(76%vs 45%,P=0.009)and LRNC(72%vs 45%,P=0.023)were significantly increased in DWI-ASPECTS≤7 group.In addition,DWI-ASPECTS≤7 group showed higher plaque burden than that of DWI-ASPECTS>7 group[maxWT(4.38±1.68)mm vs(3.47±1.78)mm,P=0.033),meanLA(15.33±11.57)mm 2 vs(22.88±13.95)mm 2,P=0.019),minLA(11.52±11.23)mm 2 vs(18.98±13.52)mm 2,P=0.017),meanWA(62.81±14.32)mm 2 vs(55.66±14.93)mm 2,P=0.045),maxWA(66.70±14.57)mm 2 vs(59.56±15.19)mm 2,P=0.049),mean NWI(81±)14%vs(71±16)%,P=0.011),max NWI(86±14)%vs(76±16)%,P=0.012)]and higher NIHSS(48%vs 23.3%,P=0.025),while HDL was higher in DWI-ASPECTS>7 group[(1.24±0.28)mmol/L vs(1.10±0.28)mmol/L,P=0.043].Binary Logistic regression analysis showed that TRFC(OR=4.133,95%CI:1.151~14.836,P=0.030)and IPH(OR=6.409,95%CI 1.737~23.646,P=0.005)were risk predictors of DWI-ASPECTS≤7.Conclusion:TRFC and IPH presented in carotid plaque were significantly associated with lower DWI-ASPECTS scores,which help to assess the severity of the ACI patients.

关 键 词：颈动脉斑块 磁共振成像 DWI-ASPECTS评分 急性脑梗死 

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]