用于筛查复杂性动脉粥样硬化性颈动脉斑块的CTA——磁共振成像定义的美国心脏协会VI型病变。
CTA for screening of complicated atherosclerotic carotid plaque--American Heart Association type VI lesions as defined by MRI.
作者信息
Trelles M, Eberhardt K M, Buchholz M, Schindler A, Bayer-Karpinska A, Dichgans M, Reiser M F, Nikolaou K, Saam T
机构信息
Department of Radiology, University of Texas Medical Branch, Galveston, Texas.
出版信息
AJNR Am J Neuroradiol. 2013 Dec;34(12):2331-7. doi: 10.3174/ajnr.A3607. Epub 2013 Jul 18.
BACKGROUND AND PURPOSE
High-resolution carotid MR imaging can accurately identify complicated American Heart Association lesion type VI plaques, which are characterized by thrombus, hemorrhage, or a ruptured fibrous cap. The purpose of this study is to evaluate whether CTA can be used as screening tool to predict the presence or absence of American Heart Association lesion type VI plaques as defined by high-resolution MR imaging.
METHODS
Fifty-one patients with suspected ischemic stroke or TIA with carotid CTA and carotid MR imaging performed within 14 days of the event/admission from April 2008 to December 2010 were reviewed. Vessels with stents or occlusion were excluded (n = 2). Each carotid artery was assigned an American Heart Association lesion type classification by MR imaging. The maximum wall thickness, maximum soft plaque component thickness, maximum calcified component thickness, and its attenuation (if the soft plaque component thickness was >2 mm) were obtained from the CTA.
RESULTS
The maximum soft plaque component thickness proved the best discriminating factor to predict a complicated plaque by MR imaging, with a receiver operating characteristic area under the curve of 0.89. The optimal sensitivity and specificity for detection of complicated plaque by MR imaging was achieved with a soft plaque component thickness threshold of 4.4 mm (sensitivity, 0.65; specificity, 0.94; positive predictive value, 0.75; and negative predictive value, 0.9). No complicated plaque had a soft tissue plaque thickness <2.2 mm (negative predictive value, 1) and no simple (noncomplicated) plaque had a thickness >5.6 mm (positive predictive value, 1).
CONCLUSIONS
Maximum soft plaque component thickness as measured by carotid CTA is a reliable indicator of a complicated plaque, with a threshold of 2.2 mm representing little to no probability of a complicated American Heart Association lesion type VI plaque.
背景与目的
高分辨率颈动脉磁共振成像能够准确识别美国心脏协会定义的Ⅵ型复杂斑块，其特征为血栓形成、出血或纤维帽破裂。本研究旨在评估CTA是否可作为筛查工具，以预测高分辨率磁共振成像所定义的美国心脏协会Ⅵ型斑块的有无。
方法
回顾性分析2008年4月至2010年12月期间51例因疑似缺血性卒中或短暂性脑缺血发作而在事件/入院后14天内接受颈动脉CTA和颈动脉磁共振成像检查的患者。排除有支架置入或血管闭塞的血管（n = 2）。通过磁共振成像对每条颈动脉进行美国心脏协会斑块类型分类。从CTA中获取最大管壁厚度、最大软斑块成分厚度、最大钙化成分厚度及其衰减值（如果软斑块成分厚度>2 mm）。
结果
最大软斑块成分厚度被证明是预测磁共振成像复杂斑块的最佳鉴别因素，曲线下面积为0.89。当软斑块成分厚度阈值为4.4 mm时，检测磁共振成像复杂斑块的灵敏度和特异度最佳（灵敏度，0.65；特异度，0.94；阳性预测值，0.75；阴性预测值，0.9）。没有复杂斑块的软组织斑块厚度<2.2 mm（阴性预测值，1），也没有单纯（非复杂）斑块的厚度>5.6 mm（阳性预测值，1）。
结论
颈动脉CTA测量的最大软斑块成分厚度是复杂斑块的可靠指标，阈值为2.2 mm时表示美国心脏协会Ⅵ型复杂斑块的可能性很小或几乎没有。
Zotero 插件