颈动脉斑块的管壁归一化指数、斑块内出血和溃疡与缺血性脑卒中的严重程度相关。

Normalized wall index, intraplaque hemorrhage and ulceration of carotid plaques correlate with the severity of ischemic stroke.

机构信息

Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China; Institute of Functional and Molecular Medical Imaging, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.

Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.

出版信息

Atherosclerosis. 2020 Dec;315:138-144. doi: 10.1016/j.atherosclerosis.2020.10.896. Epub 2020 Nov 6.

DOI:10.1016/j.atherosclerosis.2020.10.896

PMID:33183741

Abstract

BACKGROUND AND AIMS

Carotid atherosclerosis is considered an important cause of ischemic stroke. Tthis study aimed to explore the relationship between plaque features and the severity of stroke, and to identify plaque risk factors for the assessment of the severity of ischemic stroke.

METHODS

Symptomatic patients with carotid atherosclerotic plaques were prospectively recruited and underwent high-resolution vessel wall magnetic resonance imaging (VW-MRI). Two trained MRI readers independently identified intraplaque hemorrhage (IPH), calcification (CA), surface CA, deep CA, and ulceration. They measured and calculated the maximum vessel diameter (Max VD), maximum wall thickness (Max WT), total vessel area, lumen area, normalized wall index (NWI), plaque volume, IPH volume, IPH proportion, CA volume, and CA proportion. Patients were divided into two groups according to their National Institutes of Health Stroke Scale (NIHSS) scores (NIHSS ≤1 vs. NIHSS >1). Clinical characteristics and carotid plaque features were compared using the Mann-Whitney U test or Chi-square test as appropriate. Odds ratio (OR) and corresponding 95% confidence interval (CI) of plaque features to distinguish patients with NIHSS >1 were calculated. Spearman's rank correlations or Pearson correlations were determined for plaque features and NIHSS scores.

RESULTS

Of the 97 included patients, 34 (35.05%) with NIHSS >1 had significantly greater NWI (p < 0.05), larger IPH volume (p < 0.01), and greater IPH proportion (p < 0.01), and higher prevalence of IPH (OR, 5.654; 95%CI, 2.272-14.070; p < 0.01) and ulceration (OR, 2.891; 95%CI, 1.090-7.667; p = 0.033) than patients with NIHSS ≤1. Max WT (r = 0.24, p = 0.018), NWI (r = 0.22, p = 0.032), IPH (r = 0.27, p = 0.007), IPH volume (r = 0.35, p < 0.01), IPH proportion (r = 0.28, p = 0.005), and ulceration (r = 0.35, p < 0.01) had positive correlations with NIHSS scores.

CONCLUSIONS

NWI, IPH, and ulceration of carotid atherosclerotic plaque based on high-resolution VW-MRI may be useful indicators for assessing the severity of ischemic stroke in patients with atherosclerosis. NIHSS score is related to max WT, NWI, IPH, IPH volume, IPH proportion, and ulceration.

摘要

背景与目的

颈动脉粥样硬化被认为是缺血性卒中的重要原因。本研究旨在探讨斑块特征与卒中严重程度的关系，并确定斑块危险因素，以评估缺血性卒中的严重程度。

方法

前瞻性招募有症状的颈动脉粥样硬化斑块患者，并进行高分辨率血管壁磁共振成像（VW-MRI）。两名经过培训的 MRI 读者独立识别斑块内出血（IPH）、钙化（CA）、表面 CA、深部 CA 和溃疡。他们测量并计算最大血管直径（Max VD）、最大管壁厚度（Max WT）、总血管面积、管腔面积、归一化管壁指数（NWI）、斑块体积、IPH 体积、IPH 比例、CA 体积和 CA 比例。根据国立卫生研究院卒中量表（NIHSS）评分（NIHSS≤1 与 NIHSS＞1）将患者分为两组。使用 Mann-Whitney U 检验或适当的卡方检验比较临床特征和颈动脉斑块特征。计算斑块特征区分 NIHSS＞1 患者的优势比（OR）及其 95%置信区间（CI）。确定斑块特征与 NIHSS 评分之间的 Spearman 秩相关或 Pearson 相关。

结果

97 例纳入患者中，34 例（35.05%） NIHSS＞1 的患者 NWI 显著较高（p＜0.05），IPH 体积较大（p＜0.01），IPH 比例较高（p＜0.01），IPH 和溃疡的患病率更高（OR，5.654；95%CI，2.272-14.070；p＜0.01）和溃疡（OR，2.891；95%CI，1.090-7.667；p=0.033）与 NIHSS≤1 的患者相比。Max WT（r=0.24，p=0.018）、NWI（r=0.22，p=0.032）、IPH（r=0.27，p=0.007）、IPH 体积（r=0.35，p＜0.01）、IPH 比例（r=0.28，p=0.005）和溃疡（r=0.35，p＜0.01）与 NIHSS 评分呈正相关。