Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China.
Department of Neurology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, P.R. China.
J Magn Reson Imaging. 2018 Jul;48(1):66-73. doi: 10.1002/jmri.25879. Epub 2017 Oct 30.
Intracranial plaque characteristics are associated with stroke events. Differences in plaque features may explain the disconnect between stenosis severity and the presence of ischemic stroke.
To investigate the relationship between plaque characteristics and downstream perfusion changes, and their contribution to the occurrence of cerebral infarction beyond luminal stenosis.
Case control.
Forty-six patients with symptomatic middle cerebral artery (MCA) stenosis (with acute cerebral infarction, n = 30; without acute cerebral infarction, n = 16).
FIELD STRENGTH/SEQUENCE: 3.0T with 3D turbo spin echo sequence (3D-SPACE).
Luminal stenosis grade, plaque features including lesion T and T hyperintense components, plaque enhancement grade, and plaque distribution were assessed. Brain perfusion was evaluated on mean transient time maps based on the Alberta Stroke Program Early CT score (MTT-ASPECTS).
Plaque features, grade of luminal stenosis, and MTT-ASPECTS were compared between two groups. The association between plaque features and MTT-ASPECTS were assessed using Spearman's correlation analysis. Multivariate logistic regression and receiver operating characteristic (ROC) curves were constructed to assess the effect of significant variables alone and their combination in determining the occurrence of cerebral infarction.
Stronger enhanced plaques were associated with downstream lower MTT-ASPECTS (P = 0.010). Plaque enhancement grade (P = 0.039, odds ratio [OR] 5.9, 95% confidence interval [CI] 1.1-32) and MTT-ASPECTS (P = 0.003, OR 2.6, 95% CI 1.4-4.7) were associated with a recent cerebral infarction, whereas luminal stenosis grade was not (P = 0.128). The combination of MTT-ASPECTS and plaque enhancement grade provided incremental information beyond luminal stenosis grade alone. The area under the receiver operating characteristic curve (AUC) improved from 0.535 to 0.921 (P < 0.05).
Strongly enhanced plaques are associated with a higher likelihood of downstream perfusion impairment. Plaque enhancement and perfusion evaluation may play a complementary role to luminal stenosis in determining the occurrence of acute cerebral infarction.
4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.
颅内斑块特征与卒中事件有关。斑块特征的差异可能解释了狭窄程度与缺血性卒中之间的不匹配。
研究斑块特征与下游灌注变化之间的关系，以及它们对管腔狭窄以外发生脑梗死的贡献。
病例对照。
46 例症状性大脑中动脉（MCA）狭窄患者（急性脑梗死，n=30；无急性脑梗死，n=16）。
磁场强度/序列：3.0T 采用 3D 涡轮自旋回波序列（3D-SPACE）。
评估管腔狭窄程度、斑块特征（包括病变 T1 和 T1 高信号成分）、斑块强化程度和斑块分布。基于 Alberta 卒中项目早期 CT 评分（MTT-ASPECTS），在平均瞬变时间图上评估脑灌注。
比较两组间斑块特征、管腔狭窄程度和 MTT-ASPECTS。采用 Spearman 相关分析评估斑块特征与 MTT-ASPECTS 的相关性。采用多元逻辑回归和受试者工作特征（ROC）曲线评估单独及联合有意义变量对脑梗死发生的影响。
强化斑块越明显，下游 MTT-ASPECTS 越低（P=0.010）。斑块强化程度（P=0.039，优势比[OR]5.9，95%置信区间[CI]1.1-32）和 MTT-ASPECTS（P=0.003，OR 2.6，95% CI 1.4-4.7）与近期脑梗死相关，而管腔狭窄程度与脑梗死无关（P=0.128）。MTT-ASPECTS 和斑块强化程度的联合提供了管腔狭窄程度以外的附加信息。ROC 曲线下面积（AUC）从 0.535 提高到 0.921（P<0.05）。
强化斑块与下游灌注损伤的可能性更高相关。斑块强化和灌注评估可能在确定急性脑梗死的发生方面与管腔狭窄程度具有互补作用。
4 级技术功效：2 级 JMRI 2017 年。
