Prediction of silent ischemic lesions after carotid artery stenting using integrated backscatter ultrasound and magnetic resonance imaging
Prediction of silent ischemic lesions after carotid artery stenting using integrated backscatter ultrasound and magnetic resonance imaging
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DOI：
10.1016/j.atherosclerosis.2009.06.024
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发表时间：
2010-01-01
期刊：
影响因子：
5.3
通讯作者：
Iwama, Toru
中科院分区：
文献类型：
--
作者：
Yamada, Kiyofumi;Kawasaki, Masanori;Iwama, Toru
目的：颈动脉支架置入术（CAS）的一个主要问题是脑栓塞的可能性。本研究的目的是确定是否背向散射积分（IBS）超声和黑血磁共振成像（BB-MRI）可以预测一个无症状的缺血性病变后CAS.Methods的风险：我们进行了定量分析斑块的特点，在颈动脉IBS超声和BB-MRI前CAS在50例患者。我们测量了所有斑块的IBS值和T1加权图像的信号强度比（SIR）。我们还进行了扩散加权（DWI）的脑MRI之前和之后CAS。结果：在新出现的同侧无症状缺血性病变（NISIL）阳性的患者组（n = 19）中，通过IBS分析评估的相对不稳定成分面积（%UCA）在大多数狭窄病变中，SIR（60.2 +/- 23.4%和35.3 +/-19.2%，p < 0.001）和SIR（1.40 +/- 0.19和1.18 +/- 0.25，p < 0.01）高于NISI阴性组（n = 31）。从受试者工作特征曲线的分析来看，IBS测量的%UCA的50%和BB-MRI测量的SIR为1.25是预测NISIL最可靠的截止值。多因素Logistic回归分析显示，SIR（p = 0.030）、CRP水平（p = 0.041）和IBS测量的UCA %（p = 0.049）是NISIL的独立预测因素。结论：IBS超声和BB-MRI对颈动脉斑块的定量组织定征有助于预测CAS后NISIL。结论颈动脉粥样硬化斑块的形成与颈动脉粥样硬化斑块的形成密切相关，术前应进行BB-MRI或IBS超声检查，以提高颈动脉粥样硬化斑块的治疗效果。(c)2009爱思唯尔爱尔兰有限公司保留所有权利。
Objective: A major concern with carotid artery stenting ( CAS) is the potential for cerebral embolism. The purpose of this study was to determine whether integrated backscatter (IBS) ultrasound and black-blood magnetic resonance imaging (BB-MRI) can predict the risk of a silent ischemic lesion after CAS.Methods: We performed quantitative analysis of plaque characteristics in carotid arteries using IBS ultrasound and BB-MRI before CAS in 50 patients. We measured IBS values and the signal intensity ratio ( SIR) from T1 weighted images of all plaques. We also performed diffusion-weighted (DWI) MRI of the brain before and after CAS.Results: In the patient group that was positive (n = 19) for newly appearing ipsilateral silent ischemic lesions (NISIL), relative unstable component area (%UCA) evaluated by IBS analysis (60.2 +/- 23.4% and 35.3 +/- 19.2%, p < 0.001) and SIR (1.40 +/- 0.19 and 1.18 +/- 0.25, p < 0.01) in most stenotic lesions were higher than in the NISIL-negative group (n = 31). From the analysis of receiver operating characteristic curves, 50% of the %UCA measured by IBS and an SIR of 1.25 measured by BB-MRI were the most reliable cutoff values for predicting NISIL. In multivariate logistic regression analysis, the independent predictors of NISIL were SIR (p = 0.030), the CRP level (p = 0.041) and the %UCA measured by IBS (p = 0.049).Conclusions: Quantitative tissue characterization of carotid plaques using IBS ultrasound and BB-MRI was useful to predict NISIL after CAS. The plaque components in carotid arteries should be evaluated by BB-MRI or IBS ultrasound before CAS to improve the clinical outcome of this procedure. (c) 2009 Elsevier Ireland Ltd. All rights reserved.