Murphy Rachael E, Moody Alan R, Morgan Paul S, Martel Anne L, Delay G S, Allder Steve, MacSweeney Shane T, Tennant William G, Gladman John, Lowe John, Hunt Beverley J
Department of Academic Radiology, University Hospital, Nottingham, UK.
Circulation. 2003 Jun 24;107(24):3053-8. doi: 10.1161/01.CIR.0000074204.92443.37. Epub 2003 Jun 9.
It is recognized that complicated plaque largely accounts for the morbidity and mortality from atherosclerosis. Ideally, investigation of symptomatic and asymptomatic patients would identify atheromatous plaques independently of stenosis. We have previously shown that a magnetic resonance direct thrombus imaging (MRDTI) technique demonstrates complicated atheroma as high signal within the carotid arterial wall. We used this technique to examine the prevalence of complicated carotid plaque in vivo in the ipsilateral arteries of recently symptomatic patients with suspected carotid artery stenosis and to compare this with their contralateral arteries and with those of healthy age- and sex-matched controls.
The carotid arteries of 120 patients with suspected severe carotid artery stenosis and previous acute cerebral ischemia were imaged using MRDTI, as were 28 control arteries. High signal was not seen in any control artery. However, there was a 60% prevalence of high signal, suggestive of complicated plaque in the patients' ipsilateral arteries. The prevalence of high signal was significantly greater in the patients' ipsilateral vessels compared with the contralateral, asymptomatic side (60% versus 36%, chi2 P<0.001), particularly for vessels of only moderate stenosis.
MRDTI high signal suggestive of complicated plaque is prevalent in the ipsilateral carotid arteries of patients with carotid stenosis and recent cerebral ischemic events. MRDTI has a potential role in identifying "at risk" plaque, studying atherogenesis and the effects of plaque-modifying strategies.
人们认识到，复杂斑块在很大程度上导致了动脉粥样硬化的发病和死亡。理想情况下，对有症状和无症状患者的研究应能独立于狭窄情况识别出动脉粥样硬化斑块。我们之前已经表明，磁共振直接血栓成像（MRDTI）技术可将复杂动脉粥样硬化显示为颈动脉壁内的高信号。我们使用该技术来检测近期有症状且疑似颈动脉狭窄患者同侧动脉中复杂颈动脉斑块的体内患病率，并将其与对侧动脉以及年龄和性别匹配的健康对照者的动脉进行比较。
对120例疑似严重颈动脉狭窄且有过急性脑缺血的患者的颈动脉以及28条对照动脉进行了MRDTI成像。在任何对照动脉中均未观察到高信号。然而，患者同侧动脉中有60%出现高信号，提示存在复杂斑块。与对侧无症状血管相比，患者同侧血管中高信号的患病率显著更高（60%对36%，卡方检验P<0.001），特别是对于仅中度狭窄的血管。
提示存在复杂斑块的MRDTI高信号在患有颈动脉狭窄和近期脑缺血事件的患者同侧颈动脉中普遍存在。MRDTI在识别“高危”斑块、研究动脉粥样硬化发生机制以及斑块修饰策略的效果方面具有潜在作用。
