Li J Y, Sun H L, Ye Z D, Fan X Q, Liu P
Department of Cardiovascular Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China.
Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Oct 18;50(5):833-839.
To evaluate the differences of plaquecomposition and volume between symptomatic and asymptomatic patients with carotid artery stenosis by multi-detector computed tomography angiography (MDCTA).
The consecutive patients with internal carotid artery stenosis≥70% diagnosed by digital subtraction angiography (DSA) were retrospectively analyzed from July 2011 to December 2015 in Peking University China-Japan Friendship School of Clinical Medicine. The symptomatic patients were defined as those who experienced nondisabling ischemic stroke or transient cerebralis chemic symptoms, including hemispheric events oramaurosis fugaxin the last 6 months. Otherwise, the patients were considered as a symptomatic. A total of 78 patients were enrolled in the study. Of these patients, there were 35 asymptomatic patients (44.9%) and 43 symptomatic patients (55.1%). All the patients received MDCTA before DSA. According to the plaque analysis of post processing work station, carotid plaques were divided into lipid-rich necrotic coreplaques (HU≤60), fibrous plaques (60 to 130 HU) and calcified plaques (HU≥130) through the different value sthreshold of HU. The plaque volume and proportion were all calculated. The differences between the two groups were compared by statistical methods.
The proportion of calcified plaques in asymptomatic patients was significantly higher than in symptomatic patients (t=2.760, P=0.007).And the proportion of LRNC plaqueswas lower than that in symptomatic patients (Z=2.009, P=0.044). There was statistical significance between the asymptomatic and symptomatic patients. Multivariate analysis showed that there was a positive correlation between the proportion of calcified plaques and asymptomatic carotid artery stenosis (OR=0.949; 95%CI: 0.915 to 0.985; P=0.005). The proportion of LRNC plaques showed a negative correlation with asymptomatic carotid artery stenosis (OR=1.068; 95%CI: 1.021 to 1.117; P=0.004). For the symptomatic patients, when the LRNC plaque proportion was greater than 30.3%, the specificity was 94.3%, and the sensitivity was 37.2%. There was no significant difference in plaque volume and fibrous plaque proportion in both groups.
Compared with symptomatic carotid plaques, the proportion of asymptomatic calcified plaques increased but the proportion of LRNC plaques decreased. Plaque LRNC 30.3% of the total volume may represent a clinically useful cutoff. For the patients with carotid artery stenosis, MDCTA may help noninvasively risk-stratify patients.
通过多排螺旋计算机断层血管造影（MDCTA）评估有症状和无症状颈动脉狭窄患者之间斑块成分和体积的差异。
回顾性分析2011年7月至2015年12月在北京大学中日友好临床医学院经数字减影血管造影（DSA）诊断为颈内动脉狭窄≥70%的连续患者。有症状患者定义为在过去6个月内经历非致残性缺血性卒中或短暂性脑缺血症状的患者，包括半球事件或一过性黑矇。否则，患者被视为无症状。共有78例患者纳入研究。其中，无症状患者35例（44.9%），有症状患者43例（55.1%）。所有患者在DSA之前均接受MDCTA检查。根据后处理工作站的斑块分析，通过不同的HU值阈值将颈动脉斑块分为富含脂质坏死核心斑块（HU≤60）、纤维斑块（60至130 HU）和钙化斑块（HU≥130）。计算斑块体积和比例。采用统计学方法比较两组之间的差异。
无症状患者钙化斑块的比例显著高于有症状患者（t = 2.760，P = 0.007）。并且富含脂质坏死核心斑块的比例低于有症状患者（Z = 2.009，P = 0.044）。无症状和有症状患者之间存在统计学意义。多因素分析显示钙化斑块比例与无症状性颈动脉狭窄之间存在正相关（OR = 0.949；95%CI：0.915至0.985；P = 0.005）。富含脂质坏死核心斑块的比例与无症状性颈动脉狭窄呈负相关（OR = 1.068；95%CI：1.021至1.117；P = 0.004）。对于有症状患者，当富含脂质坏死核心斑块比例大于30.3%时，特异性为94.3%，敏感性为37.2%。两组在斑块体积和纤维斑块比例方面无显著差异。
与有症状的颈动脉斑块相比，无症状钙化斑块的比例增加，但富含脂质坏死核心斑块的比例降低。斑块富含脂质坏死核心占总体积的30.3%可能代表一个临床上有用的临界值。对于颈动脉狭窄患者，MDCTA可能有助于对患者进行无创风险分层。
