CT Angiographic Features of Symptom-Producing Plaque in Moderate-Grade Carotid Artery Stenosis
CT Angiographic Features of Symptom-Producing Plaque in Moderate-Grade Carotid Artery Stenosis
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DOI：
10.3174/ajnr.a4098
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发表时间：
2015-02-01
影响因子：
3.5
通讯作者：
Sanelli, P. C.
中科院分区：
文献类型：
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作者：
Gupta, A.;Mtui, E. E.;Sanelli, P. C.
背景和目的：新的证据表明斑块成像可以改善颈动脉粥样硬化患者的卒中风险分层。我们研究了 CTA 上的软斑块和硬斑块厚度测量与中度颈动脉狭窄患者的症状性疾病状态（同侧卒中或 TIA）之间的关联。 材料和方法：我们在 NASCET 50%-69% ICA 狭窄受试者的每个颈动脉斑块的 CIA 轴向源图像上测量了软斑块和硬斑块厚度。我们使用逻辑回归和接受者操作特征分析来评估厚度测量与既往卒中或 TIA 之间的关联强度。 结果：研究的 72 条血管中有 20 条 (27.7%) 在中度颈动脉狭窄同侧出现缺血症状。软斑块每增加 1 毫米，发生同侧缺血事件的几率就会增加 3.7 倍（95% CI，1.9-7.2）。相反，硬斑块每增加 1 毫米，出现症状的几率就会降低约 80%（OR，0.22；95% Cl，0.10%-0.48%）。接受者操作特征分析显示，通过使用软斑块厚度测量来区分无症状斑块和有症状斑块，曲线下面积为 0.88。通过使用最大软斑块厚度 2.2 mm 来优化敏感性和特异性，其敏感性为 85%，特异性为 83%。 结论：简单的 CTA 斑块厚度测量可以区分有症状和无症状的中度颈动脉斑块。通过进一步的前瞻性验证，CTA 斑块测量可以作为颈动脉疾病风险分层的一种易于实施的工具。
BACKGROUND AND PURPOSE: Emerging evidence indicates that plaque imaging can improve stroke risk stratification in patients with carotid artery atherosclerosis. We studied the association between soft and hard (calcified) plaque thickness measurements on CTA and symptomatic disease status (ipsilateral stroke or TIA) in patients with moderate-grade carotid artery stenosis.MATERIALS AND METHODS: We measured soft-plaque and hard-plaque thickness on CIA axial source images in each carotid artery plaque in subjects with NASCET 50%-69% ICA stenosis. We used logistic regression and receiver operating characteristic analyses to assess the strength of the association between thickness measurements and prior stroke or TIA.RESULTS: Twenty of 72 vessels studied (27.7%) had ischemic symptoms ipsilateral to the side of moderate-grade carotid stenosis. Each 1-mm increase in soft plaque resulted in a 3.7 times greater odds of a prior ipsilateral ischemic event (95% CI,1.9-7.2). Conversely, for each 1-mm increase in hard plaque, the odds of being symptomatic decreased by approximately 80% (OR, 0.22; 95% Cl, 0.10%-0.48%). Receiver operating characteristic analysis showed an area under the curve of 0.88 by using soft-plaque thickness measurements to discriminate between asymptomatic and symptomatic plaques. Sensitivity and specificity were optimized by using a maximum soft-plaque thickness of 2.2 mm, which provided a sensitivity of 85% and a specificity of 83%.CONCLUSIONS: Simple CTA plaque-thickness measurements might differentiate symptomatic and asymptomatic moderate-grade carotid artery plaque. With further prospective validation, CTA plaque measures could function as an easily implementable tool for risk stratification in carotid artery disease.