Department of Radiology, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Radiology, University of Cambridge, Cambridge, UK.
J Magn Reson Imaging. 2021 Jul;54(1):76-88. doi: 10.1002/jmri.27516. Epub 2021 Mar 10.
Intracranial atherosclerotic plaque causing mild luminal stenosis might lead to acute ischemic events. However, the difference between culprit and nonculprit lesions is unclear, as are the factors associated with favorable treatment outcomes.
To quantify characteristics of intracranial atherosclerosis with mild luminal stenosis and to identify factors associated with lesion type (culprit or nonculprit) and with clinical outcomes.
Prospective POPULATION: 293 patients who had acute stroke with mild luminal stenosis (<50%) in the middle cerebral or basilar artery.
FIELD STRENGTH/SEQUENCE: 3.0 T higher resolution magnetic resonance imaging (hrMRI) of intracranial arteries and whole brain MR images.
Morphological and compositional analysis of plaques was performed. This included assessment of plaque volume, plaque burden, remodeling ratio, eccentricity, intraplaque hemorrhage, and enhancement ratio. Clinical outcomes were assessed according to the modified Rankin Scale (mRS) at day 90, with a favorable outcome being defined as a 90-day mRS ≤2.
The odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by a logistic regression model.
Hypertension (OR 5.2; 95% CI 2.6-10.3; P < 0.05) and hrMRI enhancement ratio (OR 2.7; 95% CI 1.4-5.1; P < 0.05) were independently associated with lesion type. Patients without hypertension had significantly more (P < 0.05) favorable outcomes (124/144) than patients with hypertension (97/149). Most hypertensive patients without any previous blood pressure control (54/63) had a favorable outcome. However, these patients were significantly younger (P < 0.05) than those with adequate blood pressure control. After adjusting for all significant characteristics, hypertension duration (OR 1.19; 95% CI 1.09-1.29; P < 0.05), hypertension management (OR 2.49; 95% CI 1.18-5.26; P < 0.05), and enhancement ratio (OR 0.01; 95% CI 0.001-0.157; P < 0.05) were found to be independent high-risk factors for outcome prediction. DATA CONCLUSION: hrMRI provided incremental value over traditional risk factors in identifying higher risk intracranial atherosclerosis with mild luminal stenosis.
2 TECHNICAL EFFICACY: Stage 2.
颅内动脉粥样硬化斑块导致轻度管腔狭窄可能导致急性缺血事件。然而，罪犯病变和非罪犯病变之间的区别尚不清楚，与有利治疗结果相关的因素也不清楚。
量化轻度管腔狭窄颅内动脉粥样硬化的特征，并确定与病变类型（罪犯或非罪犯）和临床结果相关的因素。
前瞻性
293 名患有大脑中或基底动脉轻度管腔狭窄（<50%）的急性中风患者。
场强/序列：3.0T 更高分辨率磁共振成像（hrMRI）颅内动脉和全脑 MR 图像。
对斑块进行形态和成分分析。这包括评估斑块体积、斑块负担、重塑比、偏心度、斑块内出血和强化比。根据 90 天改良 Rankin 量表（mRS）评估临床结果，90 天 mRS≤2 定义为预后良好。
通过逻辑回归模型计算比值比（OR）及其 95%置信区间（CI）。
高血压（OR 5.2；95%CI 2.6-10.3；P<0.05）和 hrMRI 强化比（OR 2.7；95%CI 1.4-5.1；P<0.05）与病变类型独立相关。无高血压的患者（124/144）明显比有高血压的患者（97/149）有更多的（P<0.05）良好预后。大多数无任何既往血压控制的高血压患者（54/63）有良好的预后。然而，这些患者明显比那些有适当血压控制的患者年轻（P<0.05）。在调整所有显著特征后，高血压持续时间（OR 1.19；95%CI 1.09-1.29；P<0.05）、高血压管理（OR 2.49；95%CI 1.18-5.26；P<0.05）和强化比（OR 0.01；95%CI 0.001-0.157；P<0.05）被发现是独立的预后预测高危因素。
与传统危险因素相比，hrMRI 在识别轻度管腔狭窄颅内动脉粥样硬化的高风险方面提供了额外的价值。
2
2 级
