From the Department of Radiology (L.S., F.L., R.S., R.M.), Azienda Ospedaliero Universitaria di Cagliari, Monserrato (Cagliari), Italy
Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota.
AJNR Am J Neuroradiol. 2019 Sep;40(9):1538-1545. doi: 10.3174/ajnr.A6160. Epub 2019 Aug 8.
The presence of IPH is considered the most dangerous feature because it is significantly associated with clinical ipsilateral cerebrovascular events. Our aim was to explore the characterization of plaque with CT in symptomatic subjects with bilateral intraplaque hemorrhage.
Three-hundred-forty-three consecutive patients with recent anterior circulation ischemic events (<2 weeks) and CT of the carotid arteries (performed within 14 days of the cerebrovascular event) evaluated between June 2012 and September 2017 were analyzed for plaque volume composition to identify all subjects with bilateral intraplaque hemorrhage. Plaque volume was semiautomatically measured, and tissue components were classified according to the attenuation values such as the following: calcified (for values of ≥130 HU), mixed (for values of ≥60 and <130 HU), lipid (for values of ≥25 and <60 HU), and intraplaque hemorrhage (for values of <25 HU). Twenty-one subjects (15 men; mean age, 70 ± 11 years; range, 44-87 years) had bilateral intraplaque hemorrhage and were included in the analysis.
Volume measurement revealed significantly larger plaques on the symptomatic side compared with the asymptomatic one (mean, 28 ± 9 versus 22 ± 8 mm, = .007). Intraplaque hemorrhage volume and percentage were also significantly higher in the plaque ipsilateral to the cerebrovascular event ( < .001 and < .001, respectively). The volume of other plaque components did not show a statically significant association except for lipid and lipid + intraplaque hemorrhage percentages (23% versus 18% and 11% versus 15%), which were significantly different between the symptomatic and the asymptomatic sides (.016 and .011, respectively). The intraplaque hemorrhage/lipid ratio was higher on the symptomatic side (0.596 versus 0.171, = .001).
In patients with bilateral intraplaque hemorrhage and recent ischemic symptoms, the plaque ipsilateral to the symptomatic side has significantly larger volume and a higher percentage of intraplaque hemorrhage compared with the contralateral, asymptomatic side.
脑实质内出血（intraplaque hemorrhage，IPH）的存在被认为是最危险的特征，因为它与同侧脑血管事件有显著相关性。本研究旨在探讨有症状的双侧脑实质内出血患者的 CT 斑块特征。
回顾性分析 2012 年 6 月至 2017 年 9 月期间连续 343 例近期（<2 周）前循环缺血性事件患者的颈动脉 CT 资料，这些患者均在脑血管事件发生后 14 天内进行了检查。所有双侧脑实质内出血患者的斑块体积成分均经 CT 评估，分析斑块体积，识别所有存在双侧脑实质内出血的患者。斑块体积采用半自动方法进行测量，并根据衰减值对组织成分进行分类，如钙化（>130 HU）、混合（>60 和 <130 HU）、脂质（>25 和 <60 HU）和脑实质内出血（<25 HU）。共 21 例（男 15 例；平均年龄 70 ± 11 岁；范围：44~87 岁）双侧脑实质内出血患者纳入分析。
症状侧斑块体积明显大于无症状侧（平均 28 ± 9 比 22 ± 8 mm，P =.007）。与脑血管事件同侧的斑块内出血体积和百分比也显著更高（P<.001 和 P<.001）。除脂质和脂质+脑实质内出血百分比（23%比 18%和 11%比 15%）外，其他斑块成分的体积无统计学差异（P>.05）。症状侧的斑块内出血/脂质比值也更高（0.596 比 0.171，P =.001）。
在双侧脑实质内出血和近期缺血症状的患者中，与对侧无症状侧相比，症状侧的斑块体积明显更大，且脑实质内出血的百分比更高。
