Singh Navneet, Moody Alan R, Gladstone David J, Leung General, Ravikumar Radhakrishnan, Zhan James, Maggisano Robert
Department of Diagnostic Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview St, Toronto, ON, Canada M4N 3M5.
Radiology. 2009 Aug;252(2):502-8. doi: 10.1148/radiol.2522080792. Epub 2009 Jun 9.
To investigate the association between magnetic resonance (MR) imaging-depicted intraplaque hemorrhage (IPH) in the carotid artery wall and the risk of future ipsilateral cerebrovascular events in men with asymptomatic moderate carotid stenosis by using a rapid three-dimensional T1-weighted fat-suppressed spoiled gradient-echo sequence.
The institutional ethics review board approved this retrospective chart review and waived the requirement for written informed consent. All patients gave informed verbal consent at follow-up telephone interviews. Ninety-one men (mean age, 74.8 years; range, 47-88 years) who attended a vascular clinic between 2003 and 2006, who had asymptomatic carotid stenosis (50%-70% at Doppler ultrasonography), and who had undergone MR imaging for IPH detection were retrospectively identified. Seventy-five men with 98 eligible carotid arteries were included in the study. Patients were followed for a minimum of 1 year (mean follow-up, 24.92 months; range, 12-43 months). Kaplan-Meier survival and univariate Cox regression analyses were conducted to compare future ipsilateral cerebrovascular event rates between carotid arteries with and those without MR-depicted IPH.
Of the 98 carotid arteries included, 36 (36.7%) had MR-depicted IPH. Six cerebrovascular events (two strokes and four transient ischemic attacks) occurred in the carotid arteries with IPH, as compared with no clinical events in the carotid arteries without IPH. Univariate Cox regression analysis confirmed that MR-depicted IPH was associated with an increased risk of cerebrovascular events (hazard ratio, 3.59; 95% confidence interval: 2.48, 4.71; P < .001). MR-depicted IPH negatively predicted outcomes (negative predictive value = 100%).
In this cohort with asymptomatic moderate carotid stenosis, MR-depicted IPH was associated with future ipsilateral cerebrovascular events. Conversely, patients without MR-depicted IPH remained asymptomatic during follow-up. The absence of IPH at MR imaging, therefore, may be a reassuring marker of plaque stability and of a lower risk of thromboembolism.
通过使用快速三维T1加权脂肪抑制扰相梯度回波序列，研究磁共振（MR）成像显示的颈动脉壁内斑块内出血（IPH）与无症状性中度颈动脉狭窄男性未来同侧脑血管事件风险之间的关联。
机构伦理审查委员会批准了这项回顾性病历审查，并免除了书面知情同意的要求。所有患者在随访电话访谈中给予了知情口头同意。回顾性确定了2003年至2006年间在血管诊所就诊、患有无症状性颈动脉狭窄（多普勒超声检查显示为50%-70%）且接受过MR成像以检测IPH的91名男性（平均年龄74.8岁；范围47-88岁）。75名男性的98条符合条件的颈动脉被纳入研究。患者至少随访1年（平均随访24.92个月；范围12-43个月）。进行Kaplan-Meier生存分析和单变量Cox回归分析，以比较有和没有MR显示IPH的颈动脉之间未来同侧脑血管事件的发生率。
在纳入的98条颈动脉中，36条（36.7%）有MR显示的IPH。有IPH的颈动脉发生了6次脑血管事件（2次中风和4次短暂性脑缺血发作），而没有IPH的颈动脉没有临床事件。单变量Cox回归分析证实，MR显示的IPH与脑血管事件风险增加相关（风险比，3.59；95%置信区间：2.48，4.71；P <.001）。MR显示的IPH对结果具有负向预测作用（阴性预测值 = 100%）。
在这个无症状性中度颈动脉狭窄的队列中，MR显示的IPH与未来同侧脑血管事件相关。相反，没有MR显示IPH的患者在随访期间保持无症状。因此，MR成像中没有IPH可能是斑块稳定性和血栓栓塞风险较低的一个令人安心的标志。
