Park Moo-Seok, Kwon Soonwook, Lee Mi Ji, Kim Keon Ha, Jeon Pyoung, Park Yang-Jin, Kim Dong-Ik, Kim Young-Wook, Bang Oh Young, Chung Chin-Sang, Lee Kwang Ho, Kim Gyeong-Moon
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Neurol. 2019 Jul 16;10:765. doi: 10.3389/fneur.2019.00765. eCollection 2019.
Risk stratification of asymptomatic carotid artery stenosis (ACAS) is still an issue for carotid revascularization. We sought to identify factors associated with symptomatic carotid artery stenosis (SCAS) using multimodal imaging techniques. We retrospectively collected data on patients who underwent carotid artery revascularization. Results from duplex sonography, computerized tomography angiography, brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), perfusion-weighted imaging, and demographic profiles were compared between ACAS and SCAS patients. Differences in baseline characteristics between the two groups were balanced by the propensity matching score method. Multivariable regression analysis was performed to identify factors associated with symptomaticity of carotid artery stenosis. We compared the strength of associations between significant imaging factors and symptomatic carotid stenosis using C statistics. A total of 259 patients (asymptomatic 57.1%, symptomatic 42.9%) with carotid stenosis were included. After 1:1 propensity score matching, the multivariable regression analysis revealed that the absence of plaque calcification [Odds ratio 0.41, 95% confidence interval (CI) 0.182-0.870, = 0.023], deep white matter hyperintensity (DWMH; Odds ratio 3.46, 95% CI 1.842-6.682, < 0.001), susceptibility vessel sign seen on gradient-echo MRI (Odds ratio 2.35, 95% CI 1.113-5.107, = 0.027), and increased cerebral blood volume (CBV) seen on perfusion-weighted MRI (CBV; Odds ratio 2.17, 95% CI 1.075-4.454, = 0.032) were associated with SCAS. The combination of these variables had a fair accuracy to classify SCAS (Area under the curve 0.733, 95% CI 0.662-0.803). We identified several multimodal imaging markers independently associated with SCAS. These markers may provide information to identify ACAS patients with high risk of ischemic stroke. Future studies are needed to predict SCAS using our findings in other independent cohorts.
无症状性颈动脉狭窄（ACAS）的风险分层仍然是颈动脉血运重建的一个问题。我们试图使用多模态成像技术来确定与症状性颈动脉狭窄（SCAS）相关的因素。我们回顾性收集了接受颈动脉血运重建患者的数据。比较了ACAS和SCAS患者在双功超声、计算机断层血管造影、脑磁共振成像（MRI）、磁共振血管造影（MRA）、灌注加权成像以及人口统计学特征方面的结果。通过倾向匹配评分法平衡两组之间基线特征的差异。进行多变量回归分析以确定与颈动脉狭窄症状相关的因素。我们使用C统计量比较了显著成像因素与症状性颈动脉狭窄之间关联的强度。总共纳入了259例颈动脉狭窄患者（无症状者占57.1%，有症状者占42.9%）。经过1:1倾向评分匹配后，多变量回归分析显示，无斑块钙化[比值比0.41，95%置信区间（CI）0.182 - 0.870，P = 0.023]、深部白质高信号（DWMH；比值比3.46，95% CI 1.842 - 6.682，P < 0.001）、梯度回波MRI上可见的磁敏感血管征（比值比2.35，95% CI 1.113 - 5.107，P = 0.027）以及灌注加权MRI上脑血容量（CBV）增加（CBV；比值比2.17，95% CI 1.075 - 4.454，P = 0.032）与SCAS相关。这些变量的组合对SCAS进行分类具有一定的准确性（曲线下面积0.733，95% CI 0.662 - 0.803）。我们确定了几个与SCAS独立相关的多模态成像标志物。这些标志物可能为识别具有缺血性中风高风险的ACAS患者提供信息。未来需要在其他独立队列中使用我们的研究结果来预测SCAS。
