Thin calcification (<2 mm) can highly predict intraplaque hemorrhage in carotid plaque: the clinical significance of calcification types.
Thin calcification (<2 mm) can highly predict intraplaque hemorrhage in carotid plaque: the clinical significance of calcification types.
复制标题
薄钙化（<2毫米）可以高度预测颈动脉斑块内出血：钙化类型的临床意义。
DOI：
10.1007/s00701-022-05205-x
复制
发表时间：
2022
影响因子：
2.4
通讯作者：
Kuroda S.
中科院分区：
文献类型：
--
作者：
Kashiwazaki D;Yamamoto S;Hori E;Akioka N;Noguchi K;Kuroda S.
目的钙化的发病机制及钙化与斑块成分的关系尚不清楚。本研究探讨了易损斑块的钙化特点，特别是侧重于钙化厚度，使用计算机断层扫描血管造影和磁共振斑块imaging.MethodsDemographic，计算机断层扫描血管造影，磁共振斑块成像数据采集178例患者229处病变诊断为颈动脉狭窄。根据钙化厚度对钙化类型进行分类。我们评价了它们的特征，包括解剖位置和斑块组成，并与MR斑块成像进行比较，阐明了临床特征。结果ROC曲线分析结果表明，症状性钙化与无症状性钙化的临界值为2.04 mm（AUC;0.841，95%CI; 0.771-0.894）。钙化厚度≥ 2 mm为厚钙化，< 2 mm为薄钙化。多因素分析显示，有症状的患者在薄钙化组中的患病率显著高于其他组（P= 0.01;比值比，4.1; 95%置信区间2.8-7.2）。钙化较薄的斑块与斑块内出血相关（P< 0.01）。钙化类型的观察者间可靠性（κ）为0.962（95%置信区间，0.941-0.988）。免疫组化结果显示，在肩部病变中，细钙化组的CD 68阳性细胞数和CD 31阳性微血管数均显著高于非细钙化组（P均< 0.01）。
PurposeCalcification pathogenesis and the relationship between calcification and plaque composition remain unclear. This study explored the calcification characteristics of vulnerable plaques, especially focusing on calcification thickness, using computed tomography angiography and magnetic resonance plaque imaging.MethodsDemographic, computed tomography angiography, and magnetic resonance plaque imaging data were acquired from 178 patients with 229 lesions diagnosed with carotid stenosis. The calcification types were categorized by calcification thickness. We evaluated their features, including the anatomical location and the plaque composition compared with MR plaque imaging, and clarify the clinical characteristics. Furthermore, an immunohistochemical subgroup analysis was performed on 84 lesions treated with carotid endarterectomy.ResultsThe result of the ROC analysis suggested the threshold between symptomatic and asymptomatic calcification was 2.04 mm (AUC;0.841, 95%CI; 0.771–0.894). Calcification with ≥ 2 mm thickness was classified as thick calcification and < 2 mm thickness as thin calcification. Multivariate analysis suggested the prevalence of symptomatic patients in the thin calcification group was significantly higher than others (P= 0.01; odds ratio, 4.1; 95% confidence interval 2.8–7.2). Plaques with thin calcification were associated with plaque with intraplaque hemorrhage (P< 0.01). The interobserver reliability (κ) of calcification type was 0.962 (95% confidence interval, 0.941–0.988). Immunohistochemical analysis demonstrated that the numbers of CD68-positive cells and CD31-positive microvessels in shoulder lesions were significantly higher in the thin calcification group than in the non-thin group (bothP< 0.01).ConclusionsThin calcification was associated with plaques with intraplaque hemorrhage and had different clinical implications than thick calcification.