Kampschulte A, Ferguson M S, Kerwin W S, Polissar Nayak L, Chu B, Saam T, Hatsukami T S, Yuan C
Department of Radiology, University of Washington, Seattle, Wash 98195, USA.
Circulation. 2004 Nov 16;110(20):3239-44. doi: 10.1161/01.CIR.0000147287.23741.9A. Epub 2004 Nov 8.
Intraplaque hemorrhage and juxtaluminal hemorrhage/thrombus may differ in cause and clinical implications. This study tested the hypothesis that MRI can distinguish between intraplaque hemorrhage and juxtaluminal hemorrhage/thrombus and investigated the association between hemorrhage and underlying lesion types.
Twenty-six patients scheduled for carotid endarterectomy were imaged with a 1.5-T GE scanner by a multicontrast-weighted MRI technique. Hemorrhages were identified with previously established MRI criteria, and differentiations were made between intraplaque and juxtaluminal hemorrhage/thrombus. Corresponding histology was used to confirm the magnetic resonance findings. Tissues underlying areas of hemorrhage/thrombus were histologically categorized according to modified American Heart Association criteria. Of 190 matched sections, 140 contained areas of hemorrhage by histology, of which MRI correctly detected 134. The sensitivity and specificity for MRI to correctly identify cross sections that contained hemorrhage were 96% and 82%, respectively. Furthermore, MRI was able to distinguish juxtaluminal hemorrhage/thrombus from intraplaque hemorrhage with an accuracy of 96%. The distribution of lesion types underlying hemorrhages differed significantly (P=0.004). Intraplaque hemorrhage had an underlying lipid-rich type IV/V lesion in 55% of histological sections, whereas juxtaluminal hemorrhage/thrombus had an underlying calcified lesion type VII in 70% of sections.
In vivo high-resolution MRI can detect and differentiate intraplaque hemorrhage from juxtaluminal hemorrhage/thrombus with good accuracy. The association of hemorrhage and lesion types suggests potential differences in origin. Noninvasive MRI therefore provides a possible tool for prospectively studying differences in origin of plaque hemorrhage and the association of plaque progression and instability.
斑块内出血和管腔旁出血/血栓在病因和临床意义上可能有所不同。本研究检验了磁共振成像（MRI）能够区分斑块内出血和管腔旁出血/血栓这一假设，并研究了出血与潜在病变类型之间的关联。
26例计划接受颈动脉内膜切除术的患者通过1.5-T通用电气扫描仪采用多对比加权MRI技术进行成像。根据先前确立的MRI标准识别出血情况，并区分斑块内出血和管腔旁出血/血栓。采用相应的组织学检查来证实磁共振成像结果。根据改良的美国心脏协会标准，对出血/血栓区域下方的组织进行组织学分类。在190个匹配切片中，140个切片在组织学上含有出血区域，其中MRI正确检测出134个。MRI正确识别含有出血的横截面的敏感性和特异性分别为96%和82%。此外，MRI能够以96%的准确率区分管腔旁出血/血栓和斑块内出血。出血下方的病变类型分布存在显著差异（P = 0.004）。在55%的组织学切片中，斑块内出血下方存在富含脂质的IV/V型病变，而在70%的切片中，管腔旁出血/血栓下方存在钙化的VII型病变。
活体高分辨率MRI能够准确地检测和区分斑块内出血与管腔旁出血/血栓。出血与病变类型的关联提示了起源方面的潜在差异。因此，无创性MRI为前瞻性研究斑块出血起源的差异以及斑块进展与不稳定性之间的关联提供了一种可能的工具。
