Department of Neurosurgery and Radiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Neuroradiology. 2012 May;54(5):487-93. doi: 10.1007/s00234-011-0920-9. Epub 2011 Jul 23.
We aimed to assess the relationship between atherosclerotic carotid plaque composition analyzed using multidetector computed tomography (MDCT) and the appearance of new ischemic lesions detected by diffusion-weighted images (DWI) after carotid artery stenting (CAS).
We quantitatively and qualitatively analyzed plaque characteristics in carotid arteries using MDCT before CAS in 19 patients. Carotid plaques were expediently subdivided into four components with Hounsfield unit (HU) values of <0, 0-60, 60-130, and >600. The incidence of distal embolism was evaluated with DWI. Pearson's correlation analyses were used to assess the association between plaque composition and the incidence of cerebral embolization.
Fifteen patients (79%) demonstrated new DWI lesions after CAS. High-signal DWIs were noted as follows: one in six patients, 2 ~ 5 in five patients, 6 ~ 10 in two patients, and >10 in two patients. The mean volumes of the plaque components for HU < 0, 0-60, 60-130, and >600 were 5.4, 200, 260, and 59 mm(3), respectively. There was a strong correlation between the number of high-signal DWI lesions in the ipsilateral side and the plaque volume of HU < 0 (r = 0.927; P < 0.0001). There was a moderate correlation between the number of high-signal DWI lesions and the plaque volume of HU 0-60 (r = 0.568; P = 0.0099) and the sum total of HU < 0 and HU 0-60 (r = 0.609; P = 0.0047).
Quantitative and qualitative tissue characterization of carotid plaques using MDCT might be a useful predictor for silent ischemic lesions after CAS.
我们旨在评估使用多排螺旋计算机断层扫描（MDCT）分析的动脉粥样硬化性颈动脉斑块成分与颈动脉支架置入术（CAS）后弥散加权成像（DWI）检测到的新缺血性病变之间的关系。
我们在 19 例患者 CAS 前使用 MDCT 对颈动脉斑块进行定量和定性分析。颈动脉斑块方便地分为四个成分，根据 CT 值（HU）<0、0-60、60-130 和>600 划分。使用 DWI 评估远端栓塞的发生率。Pearson 相关分析用于评估斑块成分与脑栓塞发生率之间的关联。
15 例患者（79%）在 CAS 后出现新的 DWI 病变。高信号 DWI 如下：6 例中有 1 例，5 例中有 2-5 例，2 例中有 6-10 例，2 例中有>10 例。HU<0、0-60、60-130 和>600 的斑块成分平均体积分别为 5.4、200、260 和 59mm3。同侧高信号 DWI 病变数量与 HU<0 斑块体积之间存在强相关性（r=0.927；P<0.0001）。高信号 DWI 病变数量与 HU 0-60 斑块体积（r=0.568；P=0.0099）和 HU<0 和 HU 0-60 的总和（r=0.609；P=0.0047）之间存在中度相关性。
使用 MDCT 对颈动脉斑块进行定量和定性组织特征分析可能是预测 CAS 后无症状性缺血性病变的有用指标。
