Huo Ran, Liu Ying, Xu Huimin, Li Jin, Xin Ruijing, Xing Zhangli, Deng Shasha, Wang Tao, Yuan Huishu, Zhao Xihai
Department of Radiology, Peking University Third Hospital, Beijing, China.
Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Quant Imaging Med Surg. 2022 May;12(5):2891-2903. doi: 10.21037/qims-21-981.
To determine the predictive value of carotid plaque characteristics for the improvement of cognition in patients with moderate-to-severe carotid stenosis after carotid endarterectomy (CEA), using vessel wall magnetic resonance imaging (MRI).
This was a prospective cohort study. Patients with unilateral, moderate-to-severe carotid stenosis referred to the Peking University Third Hospital for CEA were prospectively recruited and underwent carotid vessel wall MRI within 1 week before CEA. We performed Montreal Cognitive Assessment (MoCA) within 1 week before and 3-4 days after CEA. The morphological and compositional characteristics of carotid plaques on MRI were evaluated. Improvement of cognition was defined as >10% increase of the total MoCA score after CEA compared with baseline. Carotid plaque characteristics were compared between patients with and without cognitive improvement.
In total, 105 patients (91 males; mean age, 65.5±8.4 years) were included. The volume {48.0 [interquartile range (IQR), 21.0 to 91.6] 16.3 (IQR, 8.1 to 53.1) mm; P=0.005} and cumulative slice [4.0 (IQR, 3.0 to 7.0) 3.0 (IQR, 2.0 to 5.0); P=0.019] of carotid calcification, and maximum percentage of calcification area [13.1% (IQR, 6.0% to 19.8%) 6.2% (IQR, 3.7% to 10.8%); P=0.004] were significantly smaller in participants with cognitive improvement compared to those without. Univariate logistic regression analysis showed that volume [odds ratio (OR) =0.994; 95% confidence interval (CI): 0.989 to 1.000; P=0.043] and cumulative slice (OR =0.823; 95% CI: 0.698 to 0.970; P=0.020) of carotid calcification, and maximum percentage of calcification area (OR =0.949; 95% CI: 0.909 to 0.991; P=0.018) were significantly correlated with cognitive improvement. After adjusting for confounding factors, these associations remained statistically or marginally significant (volume: OR =0.994; 95% CI: 0.988 to 1.000; P=0.057; maximum percentage of calcification area: OR =0.937; 95% CI: 0.890 to 0.987; P=0.014; and cumulative slice: OR =0.791; 95% CI: 0.646 to 0.967; P=0.022). No significant associations were found between other plaque characteristics and cognitive improvement (all P>0.05).
More than half of the participants with unilateral, moderate-to-severe carotid atherosclerotic stenosis had cognitive improvement. The size of calcification might be an effective indicator of cognitive improvement after CEA.
使用血管壁磁共振成像（MRI）确定颈动脉斑块特征对中度至重度颈动脉狭窄患者颈动脉内膜剥脱术（CEA）后认知改善的预测价值。
这是一项前瞻性队列研究。前瞻性招募转诊至北京大学第三医院接受CEA的单侧中度至重度颈动脉狭窄患者，并在CEA前1周内接受颈动脉血管壁MRI检查。我们在CEA前1周内以及CEA后3 - 4天进行蒙特利尔认知评估（MoCA）。评估MRI上颈动脉斑块的形态和成分特征。认知改善定义为CEA后MoCA总分较基线增加>10%。比较有和没有认知改善的患者之间的颈动脉斑块特征。
共纳入105例患者（91例男性；平均年龄65.5±8.4岁）。与未改善的参与者相比，认知改善的参与者的颈动脉钙化体积{48.0 [四分位数间距（IQR），21.0至91.6] 16.3（IQR，8.1至53.1）mm；P = 0.005}、累积层数[4.0（IQR，3.0至7.0） 3.0（IQR，2.0至5.0）；P = 0.019]以及钙化面积最大百分比[13.1%（IQR，6.0%至19.8%） 6.2%（IQR，3.7%至10.8%）；P = 0.004]均显著更小。单因素逻辑回归分析显示，颈动脉钙化体积[比值比（OR）=0.994；95%置信区间（CI）：0.989至1.000；P = 0.043]、累积层数（OR =0.823；95%CI：0.698至0.970；P = 0.020）以及钙化面积最大百分比（OR =0.949；95%CI：0.909至0.991；P = 0.018）与认知改善显著相关。在调整混杂因素后，这些关联仍具有统计学意义或边缘统计学意义（体积：OR =0.994；95%CI：0.988至1.000；P = 0.057；钙化面积最大百分比：OR =0.937；95%CI：0.890至0.987；P = 0.014；累积层数：OR =0.791；95%CI：0.646至0.967；P = 0.022）。未发现其他斑块特征与认知改善之间存在显著关联（所有P>0.05）。
超过一半的单侧中度至重度颈动脉粥样硬化狭窄参与者有认知改善。钙化大小可能是CEA后认知改善的有效指标。
