Plaque Hemorrhage Is a Marker of Thromboembolic Activity in Patients with Symptomatic Carotid Disease
Plaque Hemorrhage Is a Marker of Thromboembolic Activity in Patients with Symptomatic Carotid Disease
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DOI：
10.1148/radiol.10100198
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发表时间：
2011-02-01
期刊：
影响因子：
19.7
通讯作者：
Auer, Dorothee P.
中科院分区：
文献类型：
--
作者：
Altaf, Nishath;Goode, Stephen D.;Auer, Dorothee P.
目的：评估磁共振(MR)成像显示的颈动脉斑块出血与经颅多普勒成像(TCD)评估的血栓栓子活动是否相关。材料和方法：当地研究伦理委员会批准了该研究，所有患者均给予知情书面同意。2005年4月至2006年12月，前瞻性招募了有高度症状性颈动脉狭窄的患者。所有患者都接受了颈动脉的磁共振成像，以检查斑块出血情况，并进行了脑部扩散加权成像。对有症状的颈动脉进行超过1小时的经颅多普勒成像，以评估微栓子信号的存在。结果：51例患者(女性23例，男性28例；平均年龄6岁，72岁，6 11岁)接受了完整的磁共振成像，其中46例(86%)接受了完整的经颅多普勒成像。32例(63%)患者颈动脉指端有斑块出血。斑块出血的存在增加了弥散加权成像同侧异常的风险(优势比，6.2[95%可信区间：1.7，21.8]；P<；0.05)。多重弥散加权成像显示的多年龄异常仅存在于MRI所示的斑块出血患者(32例斑块出血患者中12例(38%)，19例非斑块出血患者中无一例；P<0.05)。斑块出血的存在也增加了微栓子信号的出现(优势比，6.0[95%可信区间：1.8，19.9]；P=.003)。结论：在MRI显示颈动脉斑块出血的患者中，经颅多普勒显示的自发性微栓子活动增加，脑缺血病变类型提示再发血栓事件；这些发现提示，MRI显示的斑块出血可能是血栓栓子活动的一个标志，进一步验证了颈动脉成像在识别活动性颈动脉疾病中的作用。(C)RSNA，2010年
Purpose: To assess whether carotid plaque hemorrhage depicted with magnetic resonance (MR) imaging was associated with thromboembolic activity as assessed with transcranial Doppler imaging.Materials and Methods: The local research ethics committee approved the study, and all patients gave informed written consent. Between April 2005 and December 2006, patients with high-grade symptomatic carotid stenosis were prospectively recruited. All underwent MR imaging of the carotid arteries for plaque hemorrhage and diffusion-weighted imaging of the brain. Transcranial Doppler imaging of the symptomatic carotid artery was performed over 1 hour to assess the presence of microembolic signal. To determine the relationship between the presence of plaque hemorrhage and diffusion-weighted imaging-positive signal and presence of microembolic signal, a logistic regression analysis was performed.Results: Fifty-one patients (23 women and 28 men; mean age 6 standard deviation, 72 years 6 11) underwent complete MR imaging; 46 (86%) of these patients underwent complete transcranial Doppler imaging. In 32 (63%) patients, there was plaque hemorrhage in the index carotid artery. The presence of plaque hemorrhage increased the risk for ipsilateral abnormalities at diffusion-weighted imaging (odds ratio, 6.2 [95% confidence interval: 1.7, 21.8]; P < .05). Multiple diffusion-weighted imaging-depicted abnormalities of multiple ages were present exclusively in patients with plaque hemorrhage shown at MR imaging (12 of 32 [38%] patients with plaque hemorrhage versus none of 19 patients without plaque hemorrhage; P,.05). The presence of plaque hemorrhage also increased the presence of microembolic signal (odds ratio, 6.0 [95% confidence interval: 1.8, 19.9]; P = .003).Conclusion: In patients with carotid plaque hemorrhage demonstrated at MR imaging, there was increased spontaneous microembolic activity at transcranial Doppler imaging and cerebral ischemic lesion patterns suggestive of recurrent embolic events; these findings suggest that plaque hemorrhage shown at MR imaging might be a marker of thromboembolic activity and further validate the usefulness of carotid imaging in identifying patients with active carotid arterial disease. (C)RSNA, 2010