Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study.
Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps: an in vivo 3T MRI study.
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DOI：
10.1161/atvbaha.109.192179
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发表时间：
2009-10
期刊：
影响因子：
--
通讯作者：
Yuan C
中科院分区：
文献类型：
--
作者：
Ota H;Yu W;Underhill HR;Oikawa M;Dong L;Zhao X;Polissar NL;Neradilek B;Gao T;Zhang Z;Yan Z;Guo M;Zhang Z;Hatsukami TS;Yuan C
组织学研究表明，晚期动脉粥样硬化中出血和大的富脂/坏死核心与薄或破裂的纤维帽之间存在相关性。我们通过体内3 T MRI研究了颈动脉轻度至重度狭窄的这些相关性。77例经双功超声检查至少一侧颈动脉狭窄≥50%的患者行双侧颈动脉多对比MRI扫描。记录了壁和富含脂质/坏死核心尺寸、是否存在出血和纤维帽状态（分类为完整厚、完整薄或破裂）的测量结果。排除图像质量差、闭塞或未检测到富脂/坏死核心的动脉。对于纳入的798个MRI切片，多变量有序回归分析表明，较高的富脂/坏死核心百分比（增加10%的比值比，1.49; p=0.02）和出血的存在（比值比，5.91; p<0.001）与纤维帽状态的恶化（完整薄或破裂）阶段独立相关。对于基于动脉的多变量分析，较大的最大富脂/坏死核心%和出血的存在独立地与更差的纤维帽状态相关（两者均为p<0.001）。在具有厚纤维帽的动脉中未检测到出血。在颈动脉粥样硬化的早期到晚期阶段，出血和较大的富脂/坏死核心百分比与薄或破裂的纤维帽状态独立相关。
Histological studies suggest associations between hemorrhage and large lipid-rich/necrotic cores with thin or ruptured fibrous caps in advanced atherosclerosis. We investigated these associations in carotid arteries with mild to severe stenosis by in-vivo 3T MRI. Seventy-seven patients with ≥50% carotid stenosis in at least one side by duplex ultrasound underwent bilateral multi-contrast carotid MRI scans. Measurements for wall and lipid-rich/necrotic core sizes, presence of hemorrhage and fibrous cap status (classified as intact thick, intact thin or ruptured) were recorded. Arteries with poor image quality, occlusion or no detectable lipid-rich/necrotic core were excluded. For the 798 MRI slices included, multivariate ordinal regression analysis demonstrated larger %lipid-rich/necrotic core (odds ratio for 10% increase, 1.49; p=0.02) and presence of hemorrhage (odds ratio, 5.91; p<0.001) were independently associated with a worse (intact thin or ruptured) stage of fibrous cap status. For artery-based multivariate analysis, a larger maximum %lipid-rich/necrotic core and presence of hemorrhage independently associated with worse fibrous cap status (p<0.001, for both). No hemorrhage was detected in arteries with thick fibrous caps. Hemorrhage and larger %lipid-rich/necrotic core were independently associated with a thin or ruptured fibrous cap status at an early to advanced stage of carotid atherosclerosis.