基于颈动脉斑块高分辨磁共振成像特征探究急性缺血性脑卒中的危险因素  

Risk factors for acute ischemic stroke based on high-resolution magnetic resonance imaging features of carotid plaque

作　　者：刘万晨 曹鑫 郑智佶 冯喆 耿道颖 LIU Wanchen;CAO Xin;ZHENG Zhiji;FENG Zhe;GENG Daoying(Department of Radiology,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院放射科,上海200040 [2]上海脑重大疾病智能影像工程技术研究中心 [3]复旦大学工程与应用技术研究院

出　　处：《上海医学》2024年第11期677-682,共6页Shanghai Medical Journal

基　　金：国家自然科学基金(82372048、82402393);上海市科学技术委员会科技计划项目(22TS1400900、23S31904100、22YF1405000)。

摘　　要：目的对颈动脉斑块进行高分辨磁共振(high-resolution MRI,HR-MRI)成像,结合临床信息及实验室检查,探究导致急性缺血性脑卒中的危险因素。方法回顾性收集2017年9月—2023年9月在复旦大学附属华山医院影像科行颈动脉HR-MRI血管壁成像检查的患者资料。所有患者均行3.0 T HR-MRI血管壁成像和颅脑MRI平扫,并使用头颈联合线圈和8通道头颅线圈。对于急性缺血性脑卒中患者,选择同侧颈动脉斑块作为研究对象;对于非急性缺血性脑卒中患者,两侧颈动脉均存在斑块时,则选择狭窄程度严重一侧。计算纳入患者的斑块面积、管腔面积、血管面积、斑块负荷(斑块面积/血管面积)。应用logistic回归分析颈动脉斑块HR-MRI血管壁成像特征和临床特征,研究相关患者发生急性缺血性脑卒中的危险因素,并计算其OR值和95%CI。结果本研究共纳入252例患者,其中108例为急性缺血性脑卒中患者,144例为非急性缺血性脑卒中患者,分别归入卒中组和非卒中组。与非卒中组相比,卒中组的患者血清肌酐水平、斑块负荷程度,以及斑块强化和IPH的占比均显著增高(P<0.001或P=0.038、0.041);两组间在斑块溃疡占比、斑块总体积、斑块面积、管腔面积、血管面积等实验室指标和其他临床特征的差异比较均无统计学意义(P值均>0.05)。单因素logistic回归分析显示,血清肌酐水平升高、总斑块体积增大、斑块负荷增加、斑块强化和IPH增加是患者发生急性脑卒中的危险因素(P<0.001或P=0.021、0.043、0.010)。多因素logistic回归分析显示,血清肌酐水平升高、斑块强化和IPH增加是患者发生急性脑卒中的独立危险因素(P=0.004、0.028、0.013)。结论急性缺血性脑卒中患者的颈动脉斑块HR-MRI血管壁成像特征与部分临床特征可指导该类患者诊治,应密切关注其斑块强化和IPH的特征成像,以及血清肌酐水平。Objective To explore the risk factors for acute ischemic stroke based on high-resolution magnetic resonance imaging(HR-MRI)of carotid plaques,clinical information and laboratory tests.Methods The patients who underwent 3.0T HR-MRI of carotid artery and cranial MRI plain scan at the Huashan Hospital affiliated to Fudan University from September 2017 to September 2023 was retrospectively analyzed.The head neck combined coil and 8-channel cranial coil were used.For patients with acute ischemic stroke,ipsilateral carotid artery plaques were selected as the research subjects.For patients with non-acute ischemic stroke,the side with severe stenosis was selected when plaques were present in both carotid arteries.The plaque area,luminal area,vascular area,and plaque burden(plaque area/vascular area)were calculated.Logistic regression analysis was used to assess HR-MRI vascular wall characteristics and clinical features of carotid plaques.The risk factors of acute ischemic stroke in relevant patients were investigated.Results A total of 252 patients(108 patients with acute ischemic stroke and 144 patients with non-acute ischemic stroke)were included in this study.The level of serum creatinine,plaque burden,and the proportion of patients with plaque enhancement and intraplaque hemorrhage(IPH)in the stroke group were significantly higher than those in the non stroke group(P<0.001,or P=0.038,0.041).There was no statistically significant difference in plaque ulcer proportion,total plaque volume,plaque area,luminal area,vascular area,or other clinical features between the two groups(P>0.05).Univariate logistic regression analysis showed that elevated serum creatinine,increased total plaque volume,increased plaque burden,plaque enhancement,and IPH were risk factors for acute stroke(P<0.001,or P=0.021,0.043,0.010).Multivariate logistic regression analysis showed that elevated serum creatinine,plaque enhancement,and increased IPH were independent risk factors for acute stroke(P=0.004,0.028,0.013).Conclusion HR-MRI vascular wall c

关 键 词：急性缺血性脑卒中 高分辨磁共振成像 颈动脉斑块 肌酐 

分 类 号：R445.2[医药卫生—影像医学与核医学]