Dołęga-Kozierowski Bartosz, Klimeczek Piotr, Lis Michał, Krycińska Róża, Chrapusta Anna, Zaleska-Dorobisz Urszula, Garcarek Jerzy, Witkiewicz Wojciech
Radiology Department, Regional Specialized Hospital, Wrocław, Poland.
WroVasc Integrated Cardiovascular Centre, Wrocław, Poland.
Adv Clin Exp Med. 2017 Jan-Feb;26(1):123-128. doi: 10.17219/acem/66365.
One of the main risk factors for cerebral ischemic events is atherosclerotic disease of the internal carotid artery (ICA). Nowadays, increasing attention is being paid to the relationship between the morphological features of atherosclerotic plaque and the occurrence of stroke. Several studies have demonstrated that the presence of specific vulnerable plaque types, with a large lipid core and thin fibrous cap, can be used as an independent risk predictor of cerebral ischemic events.
The present study is an attempt to develop the method of plaque surface morphology assessment presented by de Weert et al. by correlating the results of Dual Source Computed Tomography (DSCT) with those from intravascular ultrasound virtual histology (IVUS-VH).
A group of 30 symptomatic patients (13 men and 17 women; 72 ± 9 years) with ICA stenosis suspected on the basis of ultrasound imaging (US) and confirmed to be above 70% in DSCT underwent intravascular ultrasound (IVUS) imaging.
The results of DSCT were categorized according to the de Weert classification. There were 13 cases (43%) with smooth wall surfaces, 10 cases (33%) with discreet wall irregularities, and seven cases (23%) with incursions of contrast, indicating the presence of ulceration. In the IVUS-VH examinations, 4 out of 30 cases (13%) were identified as having adaptive intimal thickening (AIT), 4 (13%) as showing pathological intimal thickening (PIT), 6 (20%) with fibroatheromas (FA), six (20%) with fibrocalcific plaque (FCa), and 10 (33%) as having thin-cap fibroatheroma (TCFA), which is high-risk plaque. Comparing the above results showed that all the patients with confirmed wall ulceration in DSCT were characterized as having high-risk plaque in IVUS-VH.
Using DSCT with the de Weert classification of plaque surface morphology makes reliable detection of ulcerations possible; therefore, this could become a significant new technique to improve current imaging protocols for patients with a high risk of ischemic cerebrovascular events.
颈内动脉（ICA）粥样硬化疾病是脑缺血事件的主要危险因素之一。如今，动脉粥样硬化斑块的形态特征与中风发生之间的关系受到越来越多的关注。多项研究表明，存在特定的易损斑块类型，即脂质核心大且纤维帽薄，可作为脑缺血事件的独立风险预测指标。
本研究旨在通过将双源计算机断层扫描（DSCT）结果与血管内超声虚拟组织学（IVUS-VH）结果相关联，开发由德韦尔特等人提出的斑块表面形态评估方法。
一组30例有症状患者（13例男性和17例女性；72±9岁），根据超声成像（US）怀疑有ICA狭窄，且DSCT证实狭窄程度高于70%，接受了血管内超声（IVUS）成像。
DSCT结果根据德韦尔特分类进行归类。有13例（43%）壁表面光滑，10例（33%）有离散的壁不规则，7例（23%）有造影剂侵入，表明存在溃疡。在IVUS-VH检查中，30例中有4例（13%）被确定为适应性内膜增厚（AIT），4例（13%）表现为病理性内膜增厚（PIT），6例（20%）为纤维粥样瘤（FA），6例（20%）为纤维钙化斑块（FCa），10例（33%）为薄帽纤维粥样瘤（TCFA），即高危斑块。比较上述结果显示，DSCT中所有确诊壁溃疡的患者在IVUS-VH中均被表征为高危斑块。
使用DSCT并采用德韦尔特斑块表面形态分类可实现溃疡的可靠检测；因此，这可能成为一种重要的新技术，以改进当前针对缺血性脑血管事件高危患者的成像方案。
