应用对比增强血管壁磁共振成像技术对颈动脉内膜切除术术后再狭窄的特征进行描述。

Characterization of Restenosis following Carotid Endarterectomy Using Contrast-Enhanced Vessel Wall MR Imaging.

机构信息

From The Russell H. Morgan Department of Radiology and Radiological Sciences (W.Y., B.A.W., L.L., J.I., Y.Q.), The Johns Hopkins Hospital, Baltimore, Maryland.

Department of Radiology (H.Y.), Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.

出版信息

AJNR Am J Neuroradiol. 2022 Mar;43(3):422-428. doi: 10.3174/ajnr.A7423. Epub 2022 Feb 17.

DOI:10.3174/ajnr.A7423

PMID:35177544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8910800/

Abstract

BACKGROUND AND PURPOSE

Restenosis is an important determinant of the long-term efficacy of carotid endarterectomy. Our aim was to assess the role of high-resolution vessel wall MR imaging for characterizing restenosis after carotid endarterectomy.

MATERIALS AND METHODS

Patients who underwent vessel wall MR imaging after carotid endarterectomy were included in this study. Restenotic lesions were classified as myointimal hyperplasia or recurrent atherosclerotic plaques based on MR imaging features of lesion compositions. Imaging characteristics of myointimal hyperplasia were compared with those of normal post-carotid endarterectomy and recurrent plaque groups. Recurrent plaques were matched with primary plaques by categories of stenosis, and differences in plaque features were compared between the 2 groups.

RESULTS

Twenty-two recurrent lesions from 18 patients (14 unilateral and 4 bilateral) were classified as myointimal hyperplasia or recurrent plaque. Myointimal hyperplasia showed no difference in enhancement compared with normal post-carotid endarterectomy vessels (5 unilateral) but showed stronger enhancement than recurrent plaques (80.10% [SD, 42.42%] versus 56.74% [SD, 46.54%], = .042). A multivariate logistic regression model of plaque-feature detection in recurrent plaques compared with primary plaques adjusted for maximum wall thickness revealed that recurrent plaques were longer (OR, 4.27; 95% CI, 1.32-13.85; = .015) and more likely to involve a flow divider and side walls (OR, 6.96; 95% CI, 1.37-35.28; = .019). Recurrent plaques had a higher prevalence of intraplaque hemorrhage (61.5% versus 30.8%, = .048) by a χ test, but compositional differences were not significant in the multivariate model.

CONCLUSIONS

Vessel wall MR imaging can distinguish recurrent plaques from myointimal hyperplasia and reveal features that may differ between primary and recurrent plaques, highlighting its value for evaluating patients with carotid restenosis.

摘要

背景与目的

再狭窄是颈动脉内膜切除术长期疗效的重要决定因素。我们旨在评估高分辨率血管壁磁共振成像在评估颈动脉内膜切除术后再狭窄中的作用。

材料与方法

本研究纳入了颈动脉内膜切除术后行血管壁磁共振成像检查的患者。根据病变成分的磁共振成像特征，将再狭窄病变分为内膜增生或复发性动脉粥样硬化斑块。比较了内膜增生的影像学特征与正常颈动脉内膜切除术后和复发性斑块组的特征。将复发性斑块按狭窄程度与原发性斑块进行分类，并比较两组斑块特征的差异。

结果

18 例患者（14 例单侧，4 例双侧）的 22 个复发性病变被分为内膜增生或复发性斑块。与正常颈动脉内膜切除术后血管（5 例单侧）相比，内膜增生的强化程度无差异，但比复发性斑块强（5 例单侧）（80.10%[标准差，42.42%]比 56.74%[标准差，46.54%]，=0.042）。对复发性斑块与原发性斑块的斑块特征检测进行多元逻辑回归模型分析，调整最大管壁厚度后发现，复发性斑块更长（比值比，4.27；95%置信区间，1.32-13.85；=0.015），更有可能累及血流分隔器和侧壁（比值比，6.96；95%置信区间，1.37-35.28；=0.019）。复发性斑块的斑块内出血发生率更高（61.5%比 30.8%，=0.048），但多元模型中差异无统计学意义。