Onishi Shumpei, Ohba Shinji, Isobe Naoyuki, Ito Yoko, Takano Motoki, Maeda Yugo, Horie Nobutaka
Department of Neurosurgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Neurosurgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan.
World Neurosurg. 2023 Nov;179:e450-e457. doi: 10.1016/j.wneu.2023.08.117. Epub 2023 Sep 1.
Magnetic resonance (MR)-plaque imaging reflects the characteristics of carotid plaque. We evaluated the relationship between MR-plaque images and ischemic change after carotid artery stenting (CAS).
MR-plaque images were acquired from patients with carotid artery stenosis before CAS treatment. We calculated the relative signal intensity of plaque components compared with that of the sternocleidomastoid muscle and evaluated the presence/absence of T1-T2 mismatch and match sign. We then assessed the appearance of new ischemic lesions after CAS on diffusion-weighted imaging (DWI). Factors associated with the appearance of a high-intensity lesion on DWI were retrospectively analyzed.
A total of 64 patients with carotid artery stenoses treated with CAS were included in this study. In univariate analysis, T1-T2 mismatch sign was associated with the appearance of high-intensity lesions on DWI after CAS (odds ratio [OR], 12.00; 95% confidence interval [CI], 3.593-40.072; P < 0.0001), whereas T1-T2 match sign and high intensity on T2-weighted imaging were negatively associated (OR, 0.061, 95% CI, 0.007-0.502, P = 0.009 and OR, 0.085; 95% CI, 0.022-0.334, P = 0.0004, respectively). In multivariate logistic regression analysis, T1-T2 mismatch sign was independently associated with the appearance of a high-intensity lesion on DWI after CAS (OR, 16.695; 95% CI, 1.324-210.52; P = 0.0295).
T1-T2 mismatch sign on MR-plaque imaging is significantly associated with the appearance of new ischemic lesions after CAS. T1-T2 mismatch sign may be useful in considering treatment strategies for carotid artery stenosis.
磁共振（MR）斑块成像可反映颈动脉斑块的特征。我们评估了MR斑块图像与颈动脉支架置入术（CAS）后缺血性改变之间的关系。
在CAS治疗前，从颈动脉狭窄患者获取MR斑块图像。我们计算了斑块成分与胸锁乳突肌相比的相对信号强度，并评估了T1-T2不匹配和匹配征的有无。然后，我们在扩散加权成像（DWI）上评估了CAS后新出现的缺血性病变的表现。回顾性分析与DWI上高强度病变出现相关的因素。
本研究共纳入64例接受CAS治疗的颈动脉狭窄患者。在单因素分析中，T1-T2不匹配征与CAS后DWI上高强度病变的出现相关（比值比[OR]，12.00；95%置信区间[CI]，3.593 - 40.072；P < 0.0001），而T1-T2匹配征和T2加权成像上的高强度呈负相关（OR分别为0.061，95% CI，0.007 - 0.502，P = 0.009和OR，0.085；95% CI，0.022 - 0.334，P = 0.0004）。在多因素逻辑回归分析中，T1-T2不匹配征与CAS后DWI上高强度病变的出现独立相关（OR，16.695；95% CI，1.324 - 210.52；P = 0.0295）。
MR斑块成像上的T1-T2不匹配征与CAS后新出现的缺血性病变显著相关。T1-T2不匹配征可能有助于考虑颈动脉狭窄的治疗策略。
