颈动脉斑块内出血的 MR T1 加权成像信号：与急性脑梗死的关系。
Signal of Carotid Intraplaque Hemorrhage on MR T1-Weighted Imaging: Association with Acute Cerebral Infarct.
机构信息
From the Beijing Institute of Brain Disorders (D.Y., Y.H., D.L.), Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
Department of Biomedical Engineering (D.Y., Y.H., D.L., R.L., X.Z.), Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Beijing, China.
出版信息
AJNR Am J Neuroradiol. 2020 May;41(5):836-843. doi: 10.3174/ajnr.A6498. Epub 2020 Apr 9.
BACKGROUND AND PURPOSE
Identifying the mere presence of carotid intraplaque hemorrhage would be insufficient to accurately discriminate the presence of acute cerebral infarct. We aimed to investigate the association between signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted MR imaging and acute cerebral infarct in patients with hemorrhagic carotid plaques using MR vessel wall imaging.
MATERIALS AND METHODS
Symptomatic patients with carotid intraplaque hemorrhage were included. The signal intensity ratios of carotid intraplaque hemorrhage against muscle on T1-weighted, TOF, and MPRAGE images were measured. The acute cerebral infarct was determined on the hemisphere ipsilateral to the carotid intraplaque hemorrhage. The association between signal intensity ratios of carotid intraplaque hemorrhage and acute cerebral infarct was analyzed.
RESULTS
Of 109 included patients (mean, 66.8 ± 9.9 years of age; 96 men), 40 (36.7%) had acute cerebral infarct. Patients with acute cerebral infarct had significantly higher signal intensity ratios of carotid intraplaque hemorrhage on T1-weighted images than those without (Median, 1.44; 25-75 Percentiles, 1.14-1.82 versus Median, 1.27; 25-75 Percentiles, 1.06-1.55, = .022). Logistic regression analysis revealed that the signal intensity ratio of carotid intraplaque hemorrhage on T1-weighted images was significantly associated with acute cerebral infarct before (OR, 4.08; 95% CI, 1.34-12.40; = .013) and after (OR, 3.34; 95% CI, 1.08-10.31; = .036) adjustment for clinical confounding factors. However, this association was not significant when further adjusted for occlusion of the carotid artery ( = .058) and volumes of intraplaque hemorrhage and lipid-rich necrotic core ( = .458).
CONCLUSIONS
The signal intensity ratio of carotid intraplaque hemorrhage on T1-weighted images is associated with acute cerebral infarct in symptomatic patients with carotid hemorrhagic plaques. This association is independent of traditional risk factors but not of the size of plaque composition. The possibility of applying T1 signals of carotid intraplaque hemorrhage to predict subsequent cerebrovascular ischemic events needs to be prospectively verified.
背景与目的
仅仅识别颈动脉斑块内出血的存在不足以准确区分急性脑梗死的存在。我们旨在通过磁共振血管壁成像研究颈动脉斑块内出血的 T1 加权磁共振成像信号强度比与伴有出血性颈动脉斑块患者的急性脑梗死之间的关系。
材料与方法
纳入有症状的颈动脉斑块内出血患者。测量 T1 加权、TOF 和 MPRAGE 图像上颈动脉斑块内出血与肌肉的信号强度比。确定斑块内出血对侧大脑半球的急性脑梗死。分析颈动脉斑块内出血的信号强度比与急性脑梗死之间的关系。
结果
在 109 例纳入患者中（平均年龄 66.8 ± 9.9 岁，96 名男性），40 例（36.7%）发生急性脑梗死。发生急性脑梗死的患者 T1 加权图像上颈动脉斑块内出血的信号强度比明显高于无急性脑梗死的患者（中位数 1.44；25%至 75%分位数 1.14-1.82 与中位数 1.27；25%至 75%分位数 1.06-1.55， =.022）。Logistic 回归分析显示，T1 加权图像上颈动脉斑块内出血的信号强度比在未校正（OR，4.08；95%CI，1.34-12.40； =.013）和校正临床混杂因素后（OR，3.34；95%CI，1.08-10.31； =.036）均与急性脑梗死显著相关。然而，当进一步校正颈动脉闭塞（ =.058）和斑块内出血及富含脂质的坏死核心体积（ =.458）时，这种相关性不显著。
结论
在有症状的伴有出血性颈动脉斑块的患者中，T1 加权图像上颈动脉斑块内出血的信号强度比与急性脑梗死有关。这种关联独立于传统的危险因素，但与斑块成分的大小无关。需要前瞻性验证颈动脉斑块内出血的 T1 信号预测随后的脑血管缺血事件的可能性。
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