基于HRMR-VWI分析颈动脉斑块的特征与Plaque-RADS评分的临床应用价值  

Analysis of the characteristics of carotid plaque based on HRMR-VWI and the clinical applicationvalue of Plague-RADS score

作　　者：宋梦星 Ndamka Josephat Sylvester 李帅 彭雯佳 SONG Mengxing;Sylvester Ndamka Josephat;LI Shuai;PENG Wenjia(Department of Radiology,the First affiliated Hospital of Naval Medical University,Shanghai 200433,China;Foreign Training Group,Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院影像医学科,上海200433 [2]海军军医大学外训大队,上海200433

出　　处：《磁共振成像》2024年第12期101-108,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：上海市自然科学基金项目(编号:22ZR1478100);上海市科委医学创新研究专项(编号:22Y11911200)。

摘　　要：目的基于高分辨磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI)分析颈动脉斑块的特征并进行斑块影像报告与数据系统(Plaque Reporting And Data System,Plaque-RADS)评分,探究Plaque-RADS评分的临床应用价值。材料与方法回顾性收集2022年1月至2023年12月行HRMR-VWI的患者85例,其中梗死组33例,非梗死组52例,采用独立样本t检验或Mann-Whitney U检验,比较责任斑块与非责任斑块的各项参数,并对斑块进行Plaque-RADS评分,通过logistic回归分析筛选斑块的独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估各参数的诊断效能。结果梗死组中责任斑块33个,非责任斑块29个,非梗死组中非责任斑块102个。责任斑块的最小管腔面积、纤维化组织体积占比明显小于非责任斑块(P<0.05);责任斑块的长度、斑块体积、平均管壁厚度、最小管壁厚度、最大管壁厚度、重构指数、斑块内出血(intraplaque hemorrhage,IPH)或血栓体积、IPH或血栓体积占比明显大于非责任斑块(P<0.05);与非责任斑块相比,责任斑块的斑块负荷、狭窄度、Plaque-RADS评分更大(P<0.001)。logistic回归分析显示,斑块的长度[比值比(odds ratio,OR)=1.67,95%置信区间(confidence interval,CI):1.04~1.10]、斑块负荷(OR=3.57,95%CI:1.76~7.24)、重构指数(OR=3.26,95%CI:1.62~6.59)IPH或血栓(OR=5.33,95%CI:2.27~12.52)、Plaque-RADS评分(OR=4.66,95%CI:2.35~9.24)、狭窄度(OR=3.77,95%CI:1.98~7.15),以及平均管壁厚度(OR=2.13,95%CI:1.05~4.32)为发生急性脑梗死(acute cerebral infarction,ACI)的重要风险因素;Plaque-RADS评分预测ACI的曲线下面积(area underthecurve,AUC)为0.815(95%CI:0.732~0.898),Plaque-RADS评分联合其余各项危险因素预测ACI的AUC为0.837(95%CI:0.735~0.921)。结论颈动脉斑块存在IPH或血栓,以及斑块长度、斑块负荷、重构指数、管腔狭窄度、平均管壁厚度、Plaque-RADS评分增加,均会增加同�Objective:This study utilizes high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)to analyze the characteristics of carotid atherosclerotic plaques,and Plaque Reporting and Data System(Plaque-RADS)scoring system were performed to explore the clinical value of Plaque-RADS.Materials and Methods:A retrospective collection of 85 patients who underwent HRMR-VWI from January 2022 to December 2023 was analyzed.This cohort included 33 patients in the stroke group and 52 patients in the non-stroke group.Independent sample t-tests or Mann-Whitney U tests were used to compare parameters between culprit and non-culprit plaques.logistic regression analysis identified independent risk factors for plaque characteristics,and receiver operating characteristic(ROC)curves were used to assess the diagnostic efficiency of these parameters.Results:There were 33 culprit and 29 non-culprit plaques in the stroke group,while 102 non-culprit plaques in the non-stroke group.Culprit plaques had significantly smaller minimum lumen area and a lower percentage of fibrous tissue volume(P<0.05);They also exhibited greater plaque length,volume,average wall thickness,minimum and maximum wall thickness,remodeling index,and volume of intraplaque hemorrhage(IPH)or thrombus(P<0.05)compared to non-culprit plaques.Furthermore,compared to non-culprit plaques,culprit lesions had higher plaque burden,degree of stenosis,and Plaque-RADS scores(P<0.001).Logistic regression revealed that plaque length[odds ratio(OR)=1.67,95%confidence interval(CI):1.04-1.10)],plaque burden(OR=3.57,95%CI:1.76-7.24),remodeling index(OR=3.26,95%CI:1.62-6.59),presence of IPH or thrombus(OR=5.33,95%CI:2.27-12.52),and Plaque-RADS score(OR=4.66,95%CI:2.35-9.24),among others,were significant risk factors for ipsilateral acute cerebral infarction(ACI).The area under the curve(AUC)for Plaque-RADS scoring alone was 0.815(95%CI:0.732-0.898),and combining it with other risk factors yielded an AUC of 0.837(95%CI:0.735-0.921).Conclusions:Carotid plaques with IPH or thrombus,increa

关 键 词：颈动脉斑块 急性脑梗死 磁共振成像 高分辨磁共振血管壁成像 Plaque-RADS评分 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.5[医药卫生—诊断学]