U-King-Im J M, Tang T Y, Patterson A, Graves M J, Howarth S, Li Z-Y, Trivedi R, Bowden D, Kirkpatrick P J, Gaunt M E, Warburton E A, Antoun N M, Gillard J H
University Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
J Neurol Neurosurg Psychiatry. 2008 Aug;79(8):905-12. doi: 10.1136/jnnp.2007.127969. Epub 2008 Jan 10.
To prospectively evaluate differences in carotid plaque characteristics in symptomatic and asymptomatic patients using high resolution MRI.
20 symptomatic and 20 asymptomatic patients, with at least 50% carotid stenosis as determined by Doppler ultrasound, underwent preoperative in vivo multispectral MRI of the carotid arteries. Studies were analysed both qualitatively and quantitatively in a randomised manner by two experienced readers in consensus, blinded to clinical status, and plaques were classified according to the modified American Heart Association (AHA) criteria.
After exclusion of poor quality images, 109 MRI sections in 18 symptomatic and 19 asymptomatic patients were available for analysis. There were no significant differences in mean luminal stenosis severity (72.9% vs 67.6%; p = 0.09) or plaque burden (median plaque areas 50 mm(2) vs 50 mm(2); p = 0.858) between the symptomatic and asymptomatic groups. However, symptomatic lesions had a higher incidence of ruptured fibrous caps (36.5% vs 8.7%; p = 0.004), haemorrhage or thrombus (46.5% vs 14.0%; p<0.001), large necrotic lipid cores (63.8% vs 28.0%; p = 0.002) and complicated type VI AHA lesions (61.5% vs 28.1%; p = 0.001) compared with asymptomatic lesions. The MRI findings of plaque haemorrhage or thrombus had an odds ratio of 5.25 (95% CI 2.08 to 13.24) while thin or ruptured fibrous cap (as opposed to a thick fibrous cap) had an odds ratio of 7.94 (95% CI 2.93 to 21.51) for prediction of symptomatic clinical status.
There are significant differences in plaque characteristics between symptomatic and asymptomatic carotid atheroma and these can be detected in vivo by high resolution MRI.
使用高分辨率磁共振成像（MRI）前瞻性评估有症状和无症状患者颈动脉斑块特征的差异。
20例有症状和20例无症状患者，经多普勒超声确定至少有50%的颈动脉狭窄，术前行颈动脉的体内多光谱MRI检查。由两名经验丰富的阅片者在不知临床状态的情况下以随机方式对研究进行定性和定量分析，并根据改良的美国心脏协会（AHA）标准对斑块进行分类。
排除质量不佳的图像后，18例有症状和19例无症状患者的109个MRI切片可供分析。有症状组和无症状组之间在平均管腔狭窄严重程度（72.9%对67.6%；p = 0.09）或斑块负荷（中位斑块面积50平方毫米对50平方毫米；p = 0.858）方面无显著差异。然而，与无症状病变相比，有症状病变的纤维帽破裂发生率更高（36.5%对8.7%；p = 0.004）、出血或血栓形成发生率更高（46.5%对14.0%；p<0.001）、大的坏死脂质核心发生率更高（63.8%对28.0%；p = 0.002）以及复杂的VI型AHA病变发生率更高（61.5%对28.1%；p = 0.001）。斑块出血或血栓形成的MRI表现预测有症状临床状态的比值比为5.25（95%可信区间2.08至13.24），而薄或破裂的纤维帽（与厚纤维帽相对）的比值比为7.94（95%可信区间2.93至21.51）。
有症状和无症状颈动脉粥样硬化斑块特征存在显著差异，并且这些差异可通过高分辨率MRI在体内检测到。
