Hoshino Masashi, Shimizu Takahiro, Ogura Hana, Hagiwara Yuta, Takao Naoki, Soga Kaima, Usuki Noriko, Moriya Junji, Nakamura Hisao, Hasegawa Yasuhiro
Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan.
J Stroke Cerebrovasc Dis. 2018 Dec;27(12):3529-3534. doi: 10.1016/j.jstrokecerebrovasdis.2018.08.017. Epub 2018 Sep 7.
Carotid artery atherosclerosis is one of the major risk factors for ischemic stroke. Intraplaque neovascularization (IPN) is one of the steps toward the development of vulnerable plaque. Superb microvascular imaging (SMI) is a new ultrasonographic technique for visualizing low-velocity and microvascular flow by clutter suppression to extract flow signals from large to small vessels and enables visualization of intraplaque microvascular flow (IMVF) without echo contrast media. We aimed to investigate the association between IMVF signal in SMI and MRI plaque imaging among patients with atherosclerotic carotid stenosis. We prospectively enrolled patients (>18 years old) with mild to severe carotid stenosis (more than 50% in cross-sectional area) diagnosed by carotid ultrasonography between August 2017 and April 2018, irrespective of sex and history of stroke. A total of 40 patients (31 men, 9 women; mean age, 75.1 ± 10.0 years) were enrolled. SMI revealed IPN findings in 21 patients. SMI clearly visualized the direction of pulsatile flow movement in microvessels and IPN was easily classified into the two types of Type V (n=2) and Type E (n=19). Multivariate logistic regression analysis presented that microvascular flow signal in carotid plaque on SMI was identified as a significant predictor of intraplaque hemorrhage as evaluated by MRI (OR, 8.46; 95%CI, 1.44-49.9; p=0.018). This study demonstrated a significant association between the presence of IMVF signal in SMI and intraplaque hemorrhage characterized by high-intensity lesions on MRI T1-FFE images.
颈动脉粥样硬化是缺血性卒中的主要危险因素之一。斑块内新生血管形成（IPN）是易损斑块发展过程中的一个步骤。超微血管成像（SMI）是一种新的超声技术，通过杂波抑制来可视化低速和微血管血流，以提取从大血管到小血管的血流信号，并且无需回声造影剂就能可视化斑块内微血管血流（IMVF）。我们旨在研究动脉粥样硬化性颈动脉狭窄患者中SMI的IMVF信号与MRI斑块成像之间的关联。我们前瞻性纳入了2017年8月至2018年4月期间经颈动脉超声诊断为轻度至重度颈动脉狭窄（横截面积超过50%）的患者（年龄>18岁），不考虑性别和卒中病史。共纳入40例患者（31例男性，9例女性；平均年龄75.1±10.0岁）。SMI在21例患者中发现了IPN表现。SMI清晰地显示了微血管中搏动性血流运动的方向，IPN很容易分为V型（n=2）和E型（n=19）两种类型。多因素逻辑回归分析显示，SMI上颈动脉斑块中的微血管血流信号被确定为MRI评估的斑块内出血的显著预测因子（OR，8.46；95%CI，1.44 - 49.9；p=0.018）。本研究表明，SMI中IMVF信号的存在与MRI T1-FFE图像上以高强度病变为特征的斑块内出血之间存在显著关联。
