基于高分辨率磁共振血管壁成像评估颈动脉分叉处几何形态与动脉粥样硬化斑块易损性的相关性研究  

Study on the correlation between carotid bifurcation geometry and atherosclerotic plaque vulnerability based on high-resolution magnetic resonance vessel wall imaging

作　　者：徐彤彤 朱雨蒙 王贝茹 胡春峰 马红 XU Tongtong;ZHU Yumeng;WANG Beiru;HU Chunfeng;MA Hong(Department of Radiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221000,China)

机构地区：[1]徐州医科大学附属医院放射科,江苏徐州221000

出　　处：《实用放射学杂志》2024年第5期701-704,720,共5页Journal of Practical Radiology

摘　　要：目的利用高分辨率磁共振血管壁成像(HRMR-VWI)研究颈动脉分叉处几何形态与动脉粥样硬化斑块易损性的相关性,寻找易损斑块形成的潜在预测指标。方法回顾性分析行HRMR-VWI发现颈动脉分叉处存在斑块的104例患者的临床信息及影像学资料。测量颈动脉分叉处几何参数,判断颈动脉分叉处斑块是否为易损斑块,分为易损斑块组(69例)和稳定斑块组(35例)。分析2组间颈动脉分叉处几何形态的差异,并校正传统危险因素得出独立危险因素,进而绘制受试者工作特征(ROC)曲线。结果本研究共104例血管,与稳定斑块组相比,易损斑块组的分叉角更大(54.00vs48.80,P<0.001)、管腔扩展参数更小(1.76vs1.94,P=0.002)、流出/流入面积比更小(0.79vs0.88,P<0.001),差异性显著。经二元logistic回归校正后,分叉角、管腔扩展参数和流出/流入面积比与易损斑块形成独立相关,校正后比值比(OR)1.132每增加10°[95%置信区间(CI)1.044~1.225]、OR0.084每增加1(95%CI0.014~0.492)、OR0.357每增加0.01(95%CI0.177~0.723)。将其纳入最终预测易损斑块模型中,曲线下面积(AUC)为0.878,高于基础模型(AUC=0.664)。结论分叉角、管腔扩展参数及流出/流入面积比与易损斑块形成独立相关。颈动脉分叉处几何形态对易损斑块形成具有一定的预测效能,并对传统危险因素具有增量诊断价值,有望成为易损斑块形成的有效影像学标志物。Objective To study the correlation between carotid bifurcation geometry and atherosclerotic plaque vulnerability using high-resolution magnetic resonance vessel wal imaging(HRMR-VWI),and to seek the potential predictor for vulnerable plaque formation.Methods The clinical information and imaging data of 1o4 patients with carotid bifurcation plaque detected by HRMR-VWI were analyzed retrospectively.Carotid bifurcation geometric parameters was measured to determine whether the carotid bifurcation plaque was vulnerable plaque,and they were divided into vulnerable plaque group(69 cases)and stable plaque group(35 cases).The difference of carotid bifurcation geometry of various groups was investigated,and the influence of common traditional risk factors to obtain independent risk factors was adjusted.Receiver operating characteristic(ROC)curve was drawn.Results Among 104 carotid artery,vulnerable plaque group had larger bifurcation angle(54.00 vs 48.80,P<0.001),less luminal expansion(1.76 vs 1.94,P=0.002)and less outflow/inflow area ratio(0.79 vs 0.88,P<0.001)compared with stable plaque group.After adjusting,binary logistic regression indicated that bifurcation angle[odds ratio(OR)1.132 per 10°increase;95%confidence interval(CI)1.044-1.225],luminal expansion(OR 0.084 per 1 increase;95%CI 0.014-0.492)and outflow/inflow area ratio(OR 0.357 per 0.01 increase;95%CI 0.177-0.723)were independent risk factors of vulnerable plaque formation.Bringing them into the final model,the area under the curve(AUC)was 0.878 above the basic model(AUC=0.664).Conclusion Bifurcation angle,luminal expansion and outflow/inflow area ratio are independently associated with vulnerable plaque formation.Carotid bifurcation geometry have the certain predictive efficiency of vulnerable plaque formation and have the incremental diagnostic value to traditional risk factors,which are expected to be effective imaging makers for the formation of vulnerable plaque.

关 键 词：颈动脉粥样硬化 易损斑块 颈动脉分叉处几何形态 高分辨率磁共振血管壁成像 

分 类 号：R543.4[医药卫生—心血管疾病] R445.2[医药卫生—内科学]