Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
AJNR Am J Neuroradiol. 2012 Aug;33(7):1267-73. doi: 10.3174/ajnr.A2970. Epub 2012 Feb 16.
Serial in vivo imaging of atherosclerosis is important for understanding plaque progression and is potentially useful in predicting cardiovascular events and monitoring treatment efficacy. This prospective study aims to quantify temporal changes in carotid atherosclerotic plaque volume and plaque composition using MDCTA.
In 109 patients with TIA or ischemic stroke, serial MDCTA of the carotid arteries was performed after 5.3 ± 0.7 years. The carotid bifurcation was semiautomatically registered for paired baseline follow-up datasets. Outer vessel wall and lumen boundaries were defined using semiautomated segmentation tools. Plaque component volumes were measured using HU thresholds. Annual changes in plaque volume and plaque component proportions were calculated.
One-hundred-ninety-three carotid arteries were analyzed. Plaque volume decreased in 31% and increased in 69% of vessels (range -5.6-10.1%/year). Overall, plaque volume increased 1.2% per year (95% CI, 0.8-1.6, P ≤ .001). Plaque composition changed significantly from BL (fibrous 66.4%, lipid 28.8%, calcifications 4.8%): fibrous tissue decreased by 1.5%, lipid decreased by 1.8%, and calcification increased by 3.3% (P < .001). Intraobserver reproducibility of all volume and proportion measurements was good (ICC 0.78-1.00) and interobserver reproducibility was moderate (ICC 0.76-0.99).
Changes in carotid plaque burden and plaque composition can be quantified by using serial MDCTA. Plaque burden development is a heterogeneous and slow process.
动脉粥样硬化的连续体内成像对于理解斑块进展非常重要，并且可能有助于预测心血管事件和监测治疗效果。本前瞻性研究旨在使用 MDCTA 定量颈动脉粥样硬化斑块体积和斑块成分的时间变化。
在 109 例 TIA 或缺血性卒中患者中，在 5.3 ± 0.7 年后对颈动脉进行了连续 MDCTA 检查。使用半自动注册技术对颈动脉分叉处进行了配对的基线随访数据集的半自动注册。使用半自动分割工具定义了外血管壁和管腔边界。使用 HU 阈值测量斑块成分体积。计算斑块体积和斑块成分比例的年度变化。
共分析了 193 条颈动脉。31%的血管中斑块体积减少，69%的血管中斑块体积增加（范围 -5.6-10.1%/年）。总体而言，斑块体积每年增加 1.2%（95%CI，0.8-1.6，P ≤.001）。与基线相比，斑块成分发生了显著变化（纤维组织 66.4%，脂质 28.8%，钙化 4.8%）：纤维组织减少 1.5%，脂质减少 1.8%，钙化增加 3.3%（P <.001）。所有体积和比例测量的观察者内重复性良好（ICC 0.78-1.00），观察者间重复性中等（ICC 0.76-0.99）。
使用连续 MDCTA 可以定量颈动脉斑块负荷和斑块成分的变化。斑块负荷的发展是一个异质且缓慢的过程。
