Usman Ammara, Yuan Jianmin, Patterson Andrew J, Graves Martin J, Varty Kevin, Sadat Umar, Gillard Jonathan H
University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
J Stroke Cerebrovasc Dis. 2018 Sep;27(9):2505-2512. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.011. Epub 2018 May 24.
Atherosclerosis is a systemic inflammatory disease intertwined with neovascularization. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables the assessment of plaque neovascularization. This study aimed to explore the systemic nature of atherosclerosis by assessing difference in severity of neovascularization as quantified by DCE-MRI of vertebral arteries (VAs) between patients with symptomatic and asymptomatic carotid artery disease.
Ten consecutive patients with asymptomatic VA stenosis and concomitant symptomatic carotid artery disease (group 1) and 10 consecutive patients with asymptomatic VA stenosis and concomitant asymptomatic carotid artery disease (group 2) underwent 3-dimensional DCE-MRI of their cervical segment of VAs. A previously validated pharmacokinetic modeling approach was used for DCE-MRI analysis. K was calculated in the adventitia and plaque as a measure of neovessel permeability.
Both patient groups were comparable for demographics and comorbidities. Mean luminal stenosis was comparable for both groups (54.4% versus 52.27%, P = .32). Group 1 had higher adventitial K and plaque K (.08 ± .01 min, .07 ± .01 min) compared with Group 2 (.06 ± .01 min, .06 ± .01 min) (P = .004 and .03, respectively). Good correlation was present among the two image analysts (intraclass correlation coefficient = .78).
Vertebral Artery atheroma of patients with symptomatic carotid artery disease had increased neovessel permeability compared with the patients with asymptomatic carotid artery disease. These findings are consistent with the hypothesis that atherosclerosis is a systemic inflammatory disease. The VA atherosclerosis is likely to have increased severity of neovascularization if another arterial territory is symptomatic in the same patient cohort.
动脉粥样硬化是一种与新血管形成相互交织的全身性炎症性疾病。动态对比增强磁共振成像（DCE-MRI）能够评估斑块的新血管形成情况。本研究旨在通过评估有症状和无症状颈动脉疾病患者椎动脉（VA）的DCE-MRI定量新血管形成严重程度的差异，来探究动脉粥样硬化的全身性本质。
连续10例无症状VA狭窄并伴有有症状颈动脉疾病的患者（第1组）和连续10例无症状VA狭窄并伴有无症状颈动脉疾病的患者（第2组）接受了其VA颈椎段的三维DCE-MRI检查。采用先前验证的药代动力学建模方法进行DCE-MRI分析。计算外膜和斑块中的K值作为新血管通透性的指标。
两组患者在人口统计学和合并症方面具有可比性。两组的平均管腔狭窄程度相当（54.4%对52.27%，P = 0.32）。与第2组（0.06±0.01分钟，0.06±0.01分钟）相比，第1组的外膜K值和斑块K值更高（0.08±0.01分钟，0.07±0.01分钟）（分别为P = 0.oo4和0.03）。两位图像分析人员之间具有良好的相关性（组内相关系数 = 0.78）。
与无症状颈动脉疾病患者相比，有症状颈动脉疾病患者的椎动脉粥样硬化新血管通透性增加。这些发现与动脉粥样硬化是一种全身性炎症性疾病的假设一致。在同一患者队列中，如果另一个动脉区域有症状，VA动脉粥样硬化的新血管形成严重程度可能会增加。
