无症状性颈动脉T1高信号斑块作为后续脑血管缺血事件的危险因素

Asymptomatic Carotid T1-High-Intense Plaque as a Risk Factor for a Subsequent Cerebrovascular Ischemic Event.

作者信息

Kurosaki Yoshitaka, Yoshida Kazumichi, Fukuda Hitoshi, Handa Akira, Chin Masaki, Yamagata Sen

机构信息

Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, Japan.

出版信息

Cerebrovasc Dis. 2017;43(5-6):250-256. doi: 10.1159/000455973. Epub 2017 Mar 4.

DOI:10.1159/000455973

PMID:28259876

Abstract

BACKGROUND

Intraplaque hemorrhage, detected as a high-signal intensity on carotid MRI, is also strongly associated with ischemic events in symptomatic patients. However, in asymptomatic patients, the relationship of the T1-high intense plaque and the subsequent stroke is not clear. The aim of this study is to test the hypothesis that asymptomatic carotid T1-high intense plaque is a risk factor for a subsequent cerebrovascular ischemic event.

METHODS

Of the 1,353 consecutive patients, who underwent head and carotid MRI as part of their annual medical check-up, the imaging quality of 13 was poor and 150 did not present for follow-up examination, thus leaving 1,190 subjects for evaluation. Of the 1,190 patients, 96 patients had findings of high-signal intensity on carotid MRI and 1,094 patients did not. Cerebrovascular events were retrospectively evaluated.

RESULTS

During a mean follow-up period of 53 months, 4 patients with high-signal intensities on carotid MRI (4%) and 3 with no findings (0.3%) had a cerebrovascular ischemic event, with the occurrences significantly higher in the high-signal-intensity group. (p < 0.01) Cox regression analysis indicated that the presence of the high-intense plaque on carotid MRI (hazard ratio [HR] 4.2; 95% CI 1.0-17.1; p = 0.04), age (HR 1.1; 95% CI 1.0-1.2; p = 0.003), and diabetes mellitus (HR 7.2; 95% CI 1.8-27.4; p = 0.004) were associated with the occurrence of subsequent ischemic cerebrovascular events.

CONCLUSIONS

Asymptomatic carotid T1-high-intense plaque might be a potential high-risk factor for a subsequent cerebrovascular ischemic event.

摘要

背景

斑块内出血在颈动脉磁共振成像（MRI）上表现为高信号强度，在有症状的患者中也与缺血性事件密切相关。然而，在无症状患者中，T1高信号斑块与随后发生的中风之间的关系尚不清楚。本研究的目的是检验无症状性颈动脉T1高信号斑块是随后发生脑血管缺血事件的危险因素这一假设。

方法

在1353例连续接受头部和颈动脉MRI检查作为年度体检一部分的患者中，13例成像质量差，150例未进行随访检查，因此留下1190例受试者进行评估。在这1190例患者中，96例在颈动脉MRI上有高信号强度表现，1094例没有。对脑血管事件进行回顾性评估。

结果

在平均53个月的随访期内，颈动脉MRI上有高信号强度的4例患者（4%）和无异常表现的3例患者（0.3%）发生了脑血管缺血事件，高信号强度组的发生率明显更高（p<0.01）。Cox回归分析表明，颈动脉MRI上存在高强度斑块（风险比[HR]4.2；95%置信区间1.0 - 17.1；p = 0.04）、年龄（HR 1.1；95%置信区间1.0 - 1.2；p = 0.003）和糖尿病（HR 7.2；95%置信区间1.8 - 27.4；p = 0.004）与随后发生的缺血性脑血管事件有关。