Department of Academic Radiology, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, England.
Radiology. 2011 Feb;258(2):538-45. doi: 10.1148/radiol.10100198. Epub 2010 Dec 16.
To assess whether carotid plaque hemorrhage depicted with magnetic resonance (MR) imaging was associated with thromboembolic activity as assessed with transcranial Doppler imaging.
The local research ethics committee approved the study, and all patients gave informed written consent. Between April 2005 and December 2006, patients with high-grade symptomatic carotid stenosis were prospectively recruited. All underwent MR imaging of the carotid arteries for plaque hemorrhage and diffusion-weighted imaging of the brain. Transcranial Doppler imaging of the symptomatic carotid artery was performed over 1 hour to assess the presence of microembolic signal. To determine the relationship between the presence of plaque hemorrhage and diffusion-weighted imaging-positive signal and presence of microembolic signal, a logistic regression analysis was performed.
Fifty-one patients (23 women and 28 men; mean age ± standard deviation, 72 years ± 11) underwent complete MR imaging; 46 (86%) of these patients underwent complete transcranial Doppler imaging. In 32 (63%) patients, there was plaque hemorrhage in the index carotid artery. The presence of plaque hemorrhage increased the risk for ipsilateral abnormalities at diffusion-weighted imaging (odds ratio, 6.2 [95% confidence interval: 1.7, 21.8]; P < .05). Multiple diffusion-weighted imaging-depicted abnormalities of multiple ages were present exclusively in patients with plaque hemorrhage shown at MR imaging (12 of 32 [38%] patients with plaque hemorrhage versus none of 19 patients without plaque hemorrhage; P < .05). The presence of plaque hemorrhage also increased the presence of microembolic signal (odds ratio, 6.0 [95% confidence interval: 1.8, 19.9]; P = .003).
In patients with carotid plaque hemorrhage demonstrated at MR imaging, there was increased spontaneous microembolic activity at transcranial Doppler imaging and cerebral ischemic lesion patterns suggestive of recurrent embolic events; these findings suggest that plaque hemorrhage shown at MR imaging might be a marker of thromboembolic activity and further validate the usefulness of carotid imaging in identifying patients with active carotid arterial disease.
评估磁共振成像（MR）显示的颈动脉斑块出血与经颅多普勒成像（TCD）评估的血栓栓塞活性之间的关系。
当地研究伦理委员会批准了该研究，所有患者均签署了知情同意书。2005 年 4 月至 2006 年 12 月期间，前瞻性招募了有症状的重度颈动脉狭窄患者。所有患者均接受颈动脉 MR 成像以评估斑块出血情况和脑弥散加权成像，接受 TCD 成像以评估症状性颈动脉微栓子信号。为了确定斑块出血与弥散加权成像阳性信号及微栓子信号之间的关系，进行了逻辑回归分析。
51 例患者（23 例女性和 28 例男性；平均年龄±标准差，72 岁±11 岁）完成了完整的 MR 成像；其中 46 例（86%）患者完成了完整的 TCD 成像。32 例（63%）患者的索引颈动脉有斑块出血。斑块出血增加了同侧弥散加权成像异常的风险（比值比，6.2[95%置信区间：1.7，21.8]；P<0.05）。仅在 MR 成像显示有斑块出血的患者中存在多个弥散加权成像显示的不同年龄的多发性异常（32 例中有 12 例[38%]有斑块出血，而 19 例无斑块出血的患者中无一例有此情况；P<0.05）。斑块出血也增加了微栓子信号的出现（比值比，6.0[95%置信区间：1.8，19.9]；P=0.003）。
在 MR 成像显示颈动脉斑块出血的患者中，TCD 显示的自发性微栓子活性增加，且脑缺血病变模式提示复发性栓塞事件；这些发现表明，MR 成像显示的斑块出血可能是血栓栓塞活性的标志物，并进一步验证了颈动脉成像在识别有活动颈动脉疾病患者方面的作用。
