Liu Song, Luo Yu, Wang Chen, Tang Ruowei, Sheng Zhiguo, Xie Weiwei, Chai Shengting, Guo Yu, Chai Chao, Yang Qi, Fan Zhaoyang, Chang Binge, Xia Shuang
Radiology Department, First Central Clinical College, Tianjin Medical University, Tianjin, China.
Radiology Department, Tianjin First Central Hospital, Tianjin, China.
J Magn Reson Imaging. 2020 Jan;51(1):195-204. doi: 10.1002/jmri.26778. Epub 2019 May 8.
Atherosclerotic plaque in the middle cerebral artery (MCA) is linked to ischemic stroke events, but the relationship between plaque characteristics and cerebral perfusion is unclear.
To investigate MCA plaque characteristics between intracranial atherosclerotic patients with and without hypoperfusion area, and to identify the variables affecting hypoperfusion volume.
Retrospective.
Seventy-one patients with MCA stenosis (>50%), and all with ischemic onset in recent 2 weeks.
FIELD STRENGTH/SEQUENCE: 3.0T MRI / diffusion-weighted imaging (DWI), time-of-flight magnetic resonance angiography (TOF-MRA), inversion-recovery prepared sampling perfection with application-optimized contrast using different flip angle evolutions (IR-SPACE), dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI).
Plaque characteristics including eccentric index (EI), eccentricity, plaque length, and enhancement on MCA were measured on IR-SPACE. Pial collaterals (PCs) were evaluated on axial TOF-MRA source images. Time-to-maximum (Tmax) maps with a threshold more than 6 seconds were assessed by rapid processing of perfusion and diffusion (RAPID) software.
Two independent-samples t-tests, Mann-Whitney U-test, chi-square test, Z test, univariate and multivariate logistic analysis, and receiver operating characteristic (ROC) curve were used.
Patients with hypoperfusion had fewer eccentric plaque, lower EI, longer plaque length, and poor PCs compared with those without (P = 0.002, 0.016, 0.003, and 0.001). Eccentricity, plaque length, PCs, and hypertension were the factors independently associated with the occurrence of hypoperfusion after adjustment for risk factors of cerebrovascular disease (P = 0.014, 0.017, 0.035, and 0.018). The area under the curve (AUC) (95% confidence interval) was 0.865 (0.763-0.934) for a combination of the above four variables, which was significantly higher than any variable alone (P < 0.001, 0.016, < 0.001, and < 0.001). Patients with lower EI, concentric morphology, and grade 2 enhancement trended to have larger hypoperfusion volume (P = 0.028, 0.037, and 0.009).
Plaque eccentricity, plaque length, PCs, and hypertension showed an association with the occurrence of hypoperfusion.
4 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020;51:195-204.
大脑中动脉（MCA）的动脉粥样硬化斑块与缺血性中风事件相关，但斑块特征与脑灌注之间的关系尚不清楚。
研究有和没有低灌注区域的颅内动脉粥样硬化患者之间的MCA斑块特征，并确定影响低灌注体积的变量。
回顾性研究。
71例MCA狭窄（>50%）患者，均在最近2周内出现缺血性发病。
场强/序列：3.0T磁共振成像/扩散加权成像（DWI）、时间飞跃磁共振血管造影（TOF-MRA）、使用不同翻转角演变的反转恢复准备采样完美序列（IR-SPACE）、动态磁敏感对比灌注加权成像（DSC-PWI）。
在IR-SPACE上测量MCA的斑块特征，包括偏心指数（EI）、偏心度、斑块长度和强化情况。在轴向TOF-MRA源图像上评估软脑膜侧支循环（PCs）。通过灌注和扩散快速处理（RAPID）软件评估阈值超过6秒的达峰时间（Tmax）图。
采用两独立样本t检验、曼-惠特尼U检验、卡方检验、Z检验、单因素和多因素逻辑分析以及受试者工作特征（ROC）曲线。
与无低灌注患者相比，低灌注患者的偏心斑块较少、EI较低、斑块长度较长且PCs较差（P = 0.002、0.016、0.003和0.001）。在调整脑血管疾病危险因素后，偏心度、斑块长度、PCs和高血压是与低灌注发生独立相关的因素（P = 0.014、0.017、0.035和0.018）。上述四个变量组合的曲线下面积（AUC）（95%置信区间）为0.865（0.763 - 0.934），显著高于任何单个变量（P < 0.001、0.016、< 0.001和< 0.001）。EI较低、同心形态和2级强化的患者倾向于有更大的低灌注体积（P = 0.028、0.037和0.009）。
斑块偏心度、斑块长度、PCs和高血压与低灌注的发生有关。
4 技术效能阶段：2 《磁共振成像杂志》2020年；51:195 - 204。
