Plaque characteristics of middle cerebral artery assessed using strategically acquired gradient echo (STAGE) and vessel wall MR contribute to misery downstream perfusion in patients with intracranial atherosclerosis
Plaque characteristics of middle cerebral artery assessed using strategically acquired gradient echo (STAGE) and vessel wall MR contribute to misery downstream perfusion in patients with intracranial atherosclerosis
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DOI：
10.1007/s00330-020-07055-6
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发表时间：
2020-08
影响因子：
5.9
通讯作者：
Tong Zhang;Tong Zhang;R. Tang;R. Tang;Song Liu;Song Liu;Chao Chai;Chao Chai;Yongsheng Chen-Yongsh
中科院分区：
文献类型：
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作者：
Tong Zhang;Tong Zhang;R. Tang;R. Tang;Song Liu;Song Liu;Chao Chai;Chao Chai;Yongsheng Chen-Yongsh
目的采用策略获得梯度回声（STAGE）与高分辨率血管壁MRI （hr-vwMRI）对比评估大脑中动脉（MCA）斑块易损，探讨斑块特征与下游灌注的关系。方法根据卒中早期CT评分（MTT-ASPECTS）的阈值为6分，将71例单MCA动脉粥样硬化斑块患者分为灌注不良组和非灌注不良组。比较两组的斑块特征，包括内腔面积（IWA）、易感性、斑块内是否存在高密度（HIP）、表面不规则性、狭窄程度、重塑指数、脂质比和增强等级。根据斑块特征的组合，在STAGE和hr-vwMRI上回顾性评估每个斑块的易损性。采用Logistic回归分析和ROC曲线评价斑块特征对痛苦灌注的影响。结果以h - vwmri为参照，STAGE对易损斑块的检测效果较好。灌注不良的患者IWA更小，狭窄程度更高，表面和髋关节更不规则，增强分级更高，易感性也更高（p均< 0.01）。较高的易感性和狭窄程度是不良灌注发生的独立预测因素（p= 0.025,p= 0.048）。两变量组合的AUC为0.900。结论stage与hr-vwMRI相比，可以更好地评估MCA斑块易损性。结合hr-vwMRI斑块特征，使用STAGE评估斑块易感性提供了预测悲惨灌注的增量价值。•与ushr- vwmri相比，STAGE在评估MCA斑块易感性方面具有良好的效率。•使用STAGE评估更高的斑块易感性，基于hr-vwMRI的更高级别管腔狭窄归因于下游灌注不足。•除了传统的hr-vwMRI外，STAGE在了解斑块易感性方面提供了更多的价值。
ObjectivesTo assess plaque vulnerability of the middle cerebral artery (MCA) using strategically acquired gradient echo (STAGE) versus high-resolution vessel wall MRI (hr-vwMRI), and explore the relationship between plaque characteristics and misery downstream perfusion.MethodsNinety-one patients with single MCA atherosclerotic plaques underwent STAGE and hr-vwMRI were categorized into a group with misery perfusion and a group without based on the Alberta Stroke Program Early CT score (MTT-ASPECTS) with a threshold of 6. Plaque characteristics including inner lumen area (IWA), susceptibility, presence of hyperintensity within plaque (HIP), surface irregularity, stenosis degree, remodeling index, lipid ratio, and enhancement grade were compared between the two groups. The vulnerability of each plaque was retrospectively assessed on both STAGE and hr-vwMRI according to the combination of plaque features. Logistic regression analysis and ROC curve were performed to evaluate the effect of plaque characteristics on the presence of misery perfusion.ResultsTaking hr-vwMRI as the reference, STAGE showed good efficiency in detecting vulnerable plaques. Patients with misery perfusion had less IWA, higher stenosis degree, more irregular surface and HIP, higher enhancement grade, and susceptibility (p< 0.01 for all). Higher susceptibility and stenosis degree were independent predictors for the occurrence of misery perfusion (p= 0.025,p= 0.048). The AUC was 0.900 for the combination of the two variables.ConclusionSTAGE shows good efficiency to assess MCA plaque vulnerability versus hr-vwMRI. Plaque susceptibility evaluated using STAGE provides incremental value to predict misery perfusion combined with hr-vwMRI plaque features.Key Points•STAGE has good efficiency in evaluating MCA plaque vulnerabilityversushr-vwMRI.•Higher plaque susceptibility assessed using STAGE and higher grade luminal stenosis based on hr-vwMRI attribute to misery downstream perfusion.•STAGE provides incremental value on the understanding of plaque vulnerability in addition to conventional hr-vwMRI.