Clinical Significance of Intraplaque Hemorrhage in Low- and High-Grade Basilar Artery Stenosis on High-Resolution MRI.
Clinical Significance of Intraplaque Hemorrhage in Low- and High-Grade Basilar Artery Stenosis on High-Resolution MRI.
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高分辨率 MRI 低度和高度基底动脉狭窄斑块内出血的临床意义
DOI：
10.3174/ajnr.a5676
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发表时间：
2018-07
期刊：
影响因子：
--
通讯作者：
Liu Q
中科院分区：
文献类型：
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作者：
Zhu C;Tian X;Degnan AJ;Shi Z;Zhang X;Chen L;Teng Z;Saloner D;Lu J;Liu Q
基底动脉狭窄患者（n = 126; 66例有症状，60例无症状）接受了高分辨率MR成像。分析影像学表现（斑块内出血、对比增强、狭窄程度、最小管腔面积和斑块负荷）与症状的关系。22例患者（17.5%）发现斑块内出血，包括21例（31.8%）有症状患者和1例（1.7%）无症状患者。多变量分析显示斑块内出血是症状状态最强的独立标志物。对比增强也与症状状态独立相关。作者得出的结论是，斑块内出血存在于低度和高度狭窄的基底动脉斑块中，并且与症状性中风状态独立相关。斑块内出血可以识别高危斑块，并为无明显狭窄的卒中患者的治疗提供新的见解。背景和目的：通过高分辨率MR成像识别的颅内动脉粥样硬化斑块内出血已被研究为卒中风险的潜在标志物。然而，以前的研究仅检查了高度狭窄（狭窄程度> 50%）的颅内动脉。本研究旨在确定低级别和高级别狭窄基底动脉斑块患者斑块内出血的临床相关性。材料和方法：基底动脉狭窄患者（n = 126;平均年龄，62 ± 10岁; 66例有症状，60例无症状）接受了高分辨率MR成像。分析影像学表现（斑块内出血、对比增强、狭窄程度、最小管腔面积和斑块负荷）与症状的关系。结果：22例患者（17.5%）发生斑块内出血，其中21例（31.8%）为有症状患者，1例（1.7%）为无症状患者。多变量分析显示斑块内出血是症状状态最强的独立标志物（比值比，27.5; 95%CI，3.4 - 221.5; P = 0.002）。对比增强也与症状状态独立相关（比值比，9.9; 95%CI，1.5 - 23.6; P = 0.016）。狭窄、最小管腔面积和斑块负荷与症状无关（P> 0.05）。斑块内出血出现在低度和高度狭窄的基底动脉中（11.3%对16.3%，P = 0.63）。急性/亚急性症状性卒中患者斑块内出血的诊断性能值如下：特异性，98.3%;敏感性，31.8%;阳性预测值，95.5%;阴性预测值，56.7%。结论：斑块内出血存在于低度和高度狭窄的基底动脉斑块中，并与症状性卒中状态独立相关。斑块内出血可以识别高危斑块，并为无明显狭窄的卒中患者的治疗提供新的见解。
Patients with basilar artery stenosis (n=126; 66 symptomatic and 60 asymptomatic) underwent high-resolution MR imaging. The relationship between imaging findings (intraplaque hemorrhage, contrast enhancement, degree of stenosis, minimal lumen area, and plaque burden) and symptoms was analyzed. Intraplaque hemorrhage was identified in 22 patients (17.5%), including 21 (31.8%) symptomatic patients and 1 (1.7%) asymptomatic patient. Multivariate analysis showed that intraplaque hemorrhage was the strongest independent marker of symptomatic status. Contrast enhancement was also independently associated with symptomatic status. The authors conclude that intraplaque hemorrhage is present in both low- and high-grade stenotic basilar artery plaques and is independently associated with symptomatic stroke status. Intraplaque hemorrhage may identify high-risk plaque and provide new insight into the management of patients with stroke without significant stenosis. BACKGROUND AND PURPOSE: Intraplaque hemorrhage within intracranial atherosclerotic plaques identified by high-resolution MR imaging has been studied as a potential marker of stroke risk. However, previous studies only examined intracranial arteries with high-grade stenosis (degree of stenosis, >50%). This study aimed to ascertain the clinical relevance of intraplaque hemorrhage in patients with low- and high-grade stenotic basilar artery plaques. MATERIALS AND METHODS: Patients with basilar artery stenosis (n = 126; mean age, 62 ± 10 years; 66 symptomatic and 60 asymptomatic) underwent high-resolution MR imaging. The relationship between imaging findings (intraplaque hemorrhage, contrast enhancement, degree of stenosis, minimal lumen area, and plaque burden) and symptoms was analyzed. RESULTS: Intraplaque hemorrhage was identified in 22 patients (17.5%), including 21 (31.8%) symptomatic patients and 1 (1.7%) asymptomatic patient. Multivariate analysis showed that intraplaque hemorrhage was the strongest independent marker of symptomatic status (odds ratio, 27.5; 95% CI, 3.4–221.5; P = .002). Contrast enhancement was also independently associated with symptomatic status (odds ratio, 9.9; 95% CI, 1.5–23.6; P = .016). Stenosis, minimal lumen area, and plaque burden were not correlated with symptoms (P > .05). Intraplaque hemorrhage was present in both low- and high-grade stenotic basilar arteries (11.3% versus 16.3%, P = .63). Diagnostic performance values of intraplaque hemorrhage for patients with acute/subacute symptomatic stroke were the following: specificity, 98.3%; sensitivity, 31.8%; positive predictive value, 95.5%; and negative predictive value, 56.7%. CONCLUSIONS: Intraplaque hemorrhage is present in both low- and high-grade stenotic basilar artery plaques and is independently associated with symptomatic stroke status. Intraplaque hemorrhage may identify high-risk plaque and provide new insight into the management of patient with stroke without significant stenosis.