基于磁共振血管壁成像研究大脑中动脉粥样硬化性狭窄病人的斑块陡度与血流动力学关系  

Plaque Steepness Is Associated with Hemodynamics in Patients with Atherosclerotic Middle Cerebral Artery Stenosis

作　　者：王觅 顾军[1] 张丹凤[1] WANG Mi;GU Jun;ZHANG Dan-feng(Department of Radiology,Nanjing First Hospital,Nanjing First Hospital of Nanjing Medical University,Nanjing 210006,Jiangsu Province,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)医学影像科,江苏南京210006

出　　处：《中国CT和MRI杂志》2024年第10期4-6,共3页Chinese Journal of CT and MRI

基　　金：国家自然科学基金(82202128)。

摘　　要：目的 基于高分辨率磁共振血管壁成像和计算流体动力学技术,探讨大脑中动脉(MCA)粥样硬化性狭窄处斑块陡度与血流动力学的关系。方法收集80例缺血性脑卒中、短暂性脑缺血发作且单侧动脉粥样硬化性MCA狭窄的患者(50%~99%)进行进行常规磁共振扫描及大脑中动脉狭窄处血管壁扫描。获得斑块、血管壁、血管壁剪切力比(WSSR)、狭窄处血管壁剪切力(WSS)的数值。根据有无缺血性脑卒中将患者分为有症状组和无症状组。比较两组在斑块、血管壁和血流动力学方面的差异。计算斑块陡度与血流动力学之间的相关性。结果80例患者中症状组31例,无症状组49例。症状组较无症状组狭窄处管腔面积(LA)较小(2.33±1.12 VS 2.94±1.06,P=0.024),斑块面积(PA)较大(4.36.±2.13 VS 2.87±1.38,P=0.001),重构指数较大(1.13±0.21 VS 0.92±0.19,P=0.001),WSSR(9.93,8.42 VS 5.75,3.68,P=0.009)和WSS(52.41±16.92 VS 38.37±17.26,P=0.018)较高,斑块陡度(1.24,1.17 VS 0.94,0.91,P=0.014)较大。与无症状组相比,症状组有更多的强化斑块(24vs 13,P=0.03),正性重构(23vs20,P=0.001)。斑块陡度与WSSR呈正相关(r=0.879,P<0.001)。结论斑块陡度是MCA粥样硬化斑块的一个重要特征,在以往的研究中未引起足够的重视。大的斑块陡度更容易引起脑卒中。Objective To evaluate the relationship between plaque steepness and hemodynamics in middle cerebral artery(MCA) stenosis based on high-resolution magnetic resonance imaging and computational fluid dynamics.Methods Eighty consecutive patients with recent ischemic stro ke,tra nsient ischemic attack who accompanying with unilateral atherosclerotic MCA stenosis(50%-99%) were prospectively recruited.All patients underwent cross-sectional sca n of the stenotic MCA vessel wall.The parameters and features of the plaqu e,vessel wall,translesional wall shear stress ratio(WSSR),wall shear stress in stenosis(WSS) we re obtained.The patients were divided into sym ptomatic group and asym ptomatic group.The differences in plaque,vessel wall,and hemodynamics were compared between two groups.Correlations between the plaque steepness and hemodynamics were calculated.Results Of the 80 patients,31 were divided to sym ptomatic group,the other 49 belonged to asymptomatic group.The symptomatic group had a smaller lumen area(2.33±1.12 VS 2.9411.06,P=0.024),larger plaque area(4.36.±2.13 VS 2.8711.38,P=0.001),larger remodeling index(1.13±0.21 VS 0.92±0.19,P=0.001),higher WSSR(9.93,8.42 VS 5.75,3.68,P=0.009) and WSS(52.41116.92 VS 38.37±17.26,P=0.018),larger the radio of height/width(1.24,1.17VS 0.94,0.91,P=0.014) at the most stenotic site.The symptomatic group had more enhanced plaques(24 vs 13,P=0.03),positive remodeling patients(23 vs 20,P<0.001) than the asymptomatic group.The ratio of height/width(r=0.879,P<0.001) showed positive correlation with WSSR,respectively.Conclusion Steepness is an important feature of atherosclerotic plaques,which doesn t get enough attention in past researches.Individuals with steep plaque might be more prone to stroke.

关 键 词：斑块陡度 血流动力学 血管壁剪切力 脑卒中 

分 类 号：R322.12[医药卫生—人体解剖和组织胚胎学]