Structural analysis and magnetic resonance imaging predict plaque vulnerability: A study comparing symptomatic and asymptomatic individuals
Structural analysis and magnetic resonance imaging predict plaque vulnerability: A study comparing symptomatic and asymptomatic individuals
复制标题
DOI：
10.1016/j.jvs.2006.12.065
复制
发表时间：
2007-04-01
影响因子：
4.3
通讯作者：
Gillard, Jonathan H.
中科院分区：
文献类型：
--
作者：
Li, Zhi-Yong;Howarth, Simon P. S.;Gillard, Jonathan H.
背景：超过一半的脑缺血事件是颅外斑块破裂的结果。目前颈动脉斑块易损性的临床判断仅基于管腔狭窄；然而，越来越多的人建议还应考虑斑块形态和生物力学应力。我们使用基于体内磁共振成像（MRI）的有限元分析来模拟无症状和有症状个体斑块内的应力分布。方法。 30 名非连续受试者（15 名有症状和 15 名无症状）接受了颈动脉分叉处的高分辨率多序列体内 MRI。根据颈动脉最大狭窄点体内 MRI 得出的几何形状进行应力分析。有限元分析模型认为斑块成分是超弹性的。比较有症状和无症状个体斑块内的峰值应力。结果：在有症状斑块的肩部区域发现高应力集中，并且该组预测的最大应力显着高于无症状组（508.2 +/- 193.1 vs 269.6 +/- 107.9 kPa；P =.004）。结论。通过有限元分析，有症状患者的最大预测斑块应力高于无症状患者的预测值，这表明应力较高的斑块可能更容易出现症状和破裂。如果通过大规模纵向研究进一步验证，基于高分辨率体内 MM 的生物力学应力分析可能会成为颈动脉粥样硬化风险评估的有用工具。它可能有助于识别最有可能出现症状或轻度至中度症状性狭窄的无症状颈动脉粥样硬化患者，而这些症状目前不属于当前的临床干预指南。
Background: More than half of all cerebral ischemic events are the result of rupture of extracranial plaques. The clinical determination of carotid plaque vulnerability is currently based solely on luminal stenosis; however, it has been increasingly suggested that plaque morphology and biomechanical stress should also be considered. We used finite element analysis based on in vivo magnetic resonance imaging (MRI) to simulate the stress distributions within plaques of asymptomatic and symptomatic individuals.Methods. Thirty nonconsecutive subjects (15 symptomatic and 15 asymptomatic) underwent high-resolution multisequence in vivo MRI of the carotid bifurcation. Stress analysis was performed based on the geometry derived from in vivo MRI of the carotid artery at the point of maximal stenosis. The finite element analysis model considered plaque components to be hyperelastic. The peak stresses within the plaques of symptomatic and asymptomatic individuals were compared.Results: High stress concentrations were found at the shoulder regions of symptomatic plaques, and the maximal stresses predicted in this group were significantly higher than those in the asymptomatic group (508.2 +/- 193.1 vs 269.6 +/- 107.9 kPa; P =.004).Conclusions. Maximal predicted plaque stresses in symptomatic patients were higher than those predicted in asymptomatic patients by finite element analysis, suggesting the possibility that plaques with higher stresses may be more prone to be symptomatic and rupture. If further validated by large-scale longitudinal studies, biomechanical stress analysis based on high resolution in vivo MM could potentially act as a useful tool for risk assessment of carotid atheroma. It may help in the identification of patients with asymptomatic carotid atheroma at greatest risk of developing symptoms or mild-to-moderate symptomatic stenoses, which currently fall outside current clinical guidelines for intervention.