Differentiation of intraplaque versus juxtaluminal hemorrhage/thrombus in advanced human carotid atherosclerotic lesions by in vivo magnetic resonance imaging
Differentiation of intraplaque versus juxtaluminal hemorrhage/thrombus in advanced human carotid atherosclerotic lesions by in vivo magnetic resonance imaging
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DOI：
10.1161/01.cir.0000147287.23741.9a
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发表时间：
2004-11-16
期刊：
影响因子：
37.8
通讯作者：
Yuan, C
中科院分区：
文献类型：
--
作者：
Kampschulte, A;Ferguson, MS;Yuan, C
斑块内出血和腔内出血/血栓在病因和临床意义上可能不同。本研究测试的假设，MRI可以区分斑块内出血和动脉瘤出血/血栓和出血和潜在的病变types.Methods和结果之间的关联调查-26例患者预定颈动脉内膜切除术成像与1.5 T GE扫描仪由multicontrast加权MRI技术。根据先前确定的MRI标准识别出血，并区分斑块内出血/血栓和腔旁出血/血栓。相应的组织学用于确认磁共振结果。根据改良的美国心脏协会标准对出血/血栓区域的组织进行组织学分类。在190个匹配的切片中，140个包含组织学出血区域，其中MRI正确检测到134个。MRI正确识别包含出血的横截面的敏感性和特异性分别为96%和82%。此外，MRI能够以96%的准确度区分动脉瘤腔内出血/血栓与斑块内出血。病变类型的分布差异显著（P = 0.004）。Intraplaque出血有一个潜在的富含脂质的IV/V型病变的组织切片的55%，而prostaluminal出血/血栓有一个潜在的钙化病变类型VII在70%的section.Conclusions -在体内高分辨率MRI可以检测和区分intraplaque出血prostaluminal出血/血栓具有良好的准确性。出血和病变类型的相关性表明起源可能存在差异。因此，无创MRI为前瞻性研究斑块出血起源的差异以及斑块进展和不稳定性的相关性提供了一种可能的工具。
Background - Intraplaque hemorrhage and juxtaluminal hemorrhage/thrombus may differ in cause and clinical implications. This study tested the hypothesis that MRI can distinguish between intraplaque hemorrhage and juxtaluminal hemorrhage/thrombus and investigated the association between hemorrhage and underlying lesion types.Methods and Results - Twenty-six patients scheduled for carotid endarterectomy were imaged with a 1.5-T GE scanner by a multicontrast-weighted MRI technique. Hemorrhages were identified with previously established MRI criteria, and differentiations were made between intraplaque and juxtaluminal hemorrhage/ thrombus. Corresponding histology was used to confirm the magnetic resonance findings. Tissues underlying areas of hemorrhage/ thrombus were histologically categorized according to modified American Heart Association criteria. Of 190 matched sections, 140 contained areas of hemorrhage by histology, of which MRI correctly detected 134. The sensitivity and specificity for MRI to correctly identify cross sections that contained hemorrhage were 96% and 82%, respectively. Furthermore, MRI was able to distinguish juxtaluminal hemorrhage/ thrombus from intraplaque hemorrhage with an accuracy of 96%. The distribution of lesion types underlying hemorrhages differed significantly (P = 0.004). Intraplaque hemorrhage had an underlying lipid-rich type IV/V lesion in 55% of histological sections, whereas juxtaluminal hemorrhage/ thrombus had an underlying calcified lesion type VII in 70% of sections.Conclusions - In vivo high-resolution MRI can detect and differentiate intraplaque hemorrhage from juxtaluminal hemorrhage/ thrombus with good accuracy. The association of hemorrhage and lesion types suggests potential differences in origin. Noninvasive MRI therefore provides a possible tool for prospectively studying differences in origin of plaque hemorrhage and the association of plaque progression and instability.