Xu Yilan, Li Dongye, Yuan Chun, Zhou Zechen, He Le, Li Rui, Cui Yuanyuan, Li Qing, Zheng Zhuozhao, Zhao Xihai
Department of Radiology Beijing Tsinghua Changgung Hospital School of Clinical Medicine Tsinghua University Beijing China.
Center for Biomedical Imaging Research Department of Biomedical Engineering Tsinghua University School of Medicine Beijing China.
Ann Clin Transl Neurol. 2018 Jun 4;5(7):843-849. doi: 10.1002/acn3.590. eCollection 2018 Jul.
This study sought to investigate the relationship of atherosclerosis between intracranial and extracranial carotid arteries using three-dimensional multicontrast magnetic resonance (MR) vessel wall imaging.
Patients with recent cerebrovascular symptoms in anterior circulation were recruited and underwent MR vessel wall imaging for intracranial and extracranial carotid arteries. The plaque burden, including maximum wall thickness (Max WT) and stenosis, and presence of intraplaque hemorrhage (IPH) were assessed. The correlation of the plaque characteristics between intracranial and extracranial carotid arteries was determined.
In total, 107 patients (mean age: 57.0 ± 11.1 years, 69 males) were recruited. In discriminating intracranial severe stenosis (≥50% stenosis), the odds ratio (OR) of Max WT of extracranial carotid arteries was 1.41 (95% confidence interval [CI], 0.94-2.11, = 0.095) and 1.72 (95% CI, 1.04-2.83, = 0.034) before and after adjusting for confounding factors, respectively. The OR of stenosis of extracranial carotid arteries with increment of 10% was 1.26 (95% CI, 0.99-1.60, = 0.054) and 1.37 (95% CI, 1.03-1.82, = 0.033) before and after adjusting for confounding factors, in discriminating intracranial severe stenosis respectively. Receiver operating characteristic analysis revealed that the area under the curve (AUC) of Max WT, stenosis, and IPH of extracranial carotid artery plaques was 0.641, 0.605, and 0.603 in discriminating intracranial severe stenosis, respectively. After adjusting for confounding factors, the AUC of Max WT, stenosis, and presence of IPH in extracranial carotid artery plaques increased to 0.812, 0.817 and 0.781, respectively.
Carotid artery plaque burden is significantly associated with severe intracranial artery stenosis, suggesting that extracranial carotid plaque burden might be an independent indicator for severity of intracranial artery atherosclerosis.
本研究旨在使用三维多对比磁共振（MR）血管壁成像技术，探究颅内和颅外颈动脉粥样硬化之间的关系。
招募前循环近期出现脑血管症状的患者，对其颅内和颅外颈动脉进行MR血管壁成像检查。评估斑块负荷，包括最大管壁厚度（Max WT）和狭窄程度，以及斑块内出血（IPH）的情况。确定颅内和颅外颈动脉斑块特征之间的相关性。
共招募了107例患者（平均年龄：57.0±11.1岁，男性69例）。在鉴别颅内严重狭窄（≥50%狭窄）时，颅外颈动脉Max WT的比值比（OR）在调整混杂因素之前为1.41（95%置信区间[CI]，0.94 - 2.11，P = 0.095），调整后为1.72（95% CI，1.04 - 2.83，P = 0.034）。在鉴别颅内严重狭窄时，颅外颈动脉狭窄程度每增加10%的OR在调整混杂因素之前为1.26（95% CI，0.99 - 1.60，P = 0.054），调整后为1.37（95% CI，1.03 - 1.82，P = 0.033）。受试者工作特征分析显示，在鉴别颅内严重狭窄时，颅外颈动脉斑块的Max WT、狭窄程度和IPH的曲线下面积（AUC）分别为0.641、0.605和0.603。调整混杂因素后，颅外颈动脉斑块的Max WT、狭窄程度和IPH存在情况的AUC分别增至0.812、0.817和0.781。
颈动脉斑块负荷与颅内动脉严重狭窄显著相关，提示颅外颈动脉斑块负荷可能是颅内动脉粥样硬化严重程度的独立指标。
