Identification of the Distal End of Carotid Plaque Using 3-Dimensional Fast Spin Echo T1-Weighted Magnetic Resonance Plaque Imaging.
Identification of the Distal End of Carotid Plaque Using 3-Dimensional Fast Spin Echo T1-Weighted Magnetic Resonance Plaque Imaging.
复制标题
使用 3 维快速旋转回波 T1 加权磁共振斑块成像识别颈动脉斑块远端。
DOI：
10.1016/j.jstrokecerebrovasdis.2020.104680
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Ogasawara K.
中科院分区：
文献类型：
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作者：
Chida K;Shimada Y;Fujimoto K;Yoshida J;Kojima D;Fujiwara S;Kobayashi M;Yoshida K;Sasaki M;Ogasawara K.
背景：在颈动脉内膜切除术（CEA）中，完全清除斑块远端是避免术后并发症的重要要求。术前识别斑块远端有助于完全清除斑块。三维（3D）磁共振（MR）斑块成像已被广泛用于评估颈动脉斑块的特性。本研究的目的是确定是否术前三维快速自旋回波（FSE）T1加权磁共振斑块成像可以识别颈动脉斑块的远端。方法：本研究被设计为一个前瞻性队列研究。我们检查了50例颈颈内动脉（伊卡）狭窄的患者，他们接受了CEA。术前使用1.5T扫描仪对受影响的颈动脉分叉进行3D-FSE T1加权MR斑块成像。在MR斑块成像上进行斑块远端识别（DEMRI），并测量与基线的距离（DistanceMRI）。术中根据颈动脉斑块成像测量结果，在伊卡上标记颈动脉斑块叠加远端（Esim）。然后在动脉切开术后确定斑块的实际远端（DECEA），并测量Esim和DECEA之间的差异（DifferenceCEA-MRI）。使用MR斑块成像计算颈动脉斑块的对比度和伊卡的迂曲度。结果：观察者之间在测量DistanceMRI方面的一致性非常好（组内相关系数为0.955; 95%置信区间为0.922 - 0.974）。28例（56%）Esim与DECEA相同。CEA-MRI平均差值为1.32 ± 1.77 mm。纤维化斑块的CEA-MRI差值（4.14 ± 1.21 mm）显著大于富脂或坏死斑块（0.43 ± 0.87 mm;P <0.05）或出血斑块（1.27 ± 1.64 mm;P <0.05）。颈内伊卡迂曲度小于120°组的CEA-MRI平均差值（3.86 ± 1.77 mm）显著大于大于等于120°但小于等于150°组（1.15 ± 1.51 mm;P <0.05）或大于150 °组（0.50 ± 1.10 mm;P <0.05）。没有病人表现出术后残余狭窄的术后MR angiography.Conclusions：使用3D-FSE T1加权磁共振斑块成像允许识别颈动脉斑块的远端，并有助于完全去除斑块，虽然它可能会减少低信号强度斑块或严重迂曲的ICA的情况下。
Background:Complete removal of the distal end of the plaque is an important requirement in carotid endarterectomy (CEA) to avoid postoperative complication. Preoperative identification of the distal end of plaque contributes to complete plaque removal. Three-dimensional (3D) magnetic resonance (MR) plaque imaging has been widely used to evaluate carotid plaque characterization. The purpose of the present study was to determine whether preoperative 3D fast spin echo (FSE) T1-weighted MR plaque imaging could identify the distal end of carotid plaque.Methods:This study was designed as a prospective cohort study. We examined 50 patients with cervical internal carotid artery (ICA) stenosis who underwent CEA. 3D-FSE T1-weighted MR plaque imaging of the affected carotid bifurcation was preoperatively performed using a 1.5-T scanner. Identification of the distal end of plaque (DEMRI) on MR plaque imaging was performed and the distance from the baseline (DistanceMRI) was measured. Intraoperatively, the superimposed distal end of carotid plaque (Esim) was marked on the ICA according to the measurement on MR plaque imaging. The actual distal end of plaque (DECEA) was then identified after arteriotomy and the difference (DifferenceCEA-MRI) between Esimand DECEAwas measured. Contrast ratio of carotid plaque and tortuosity of the ICA were calculated using MR plaque imaging.Results:Interobserver agreements in measurement of DistanceMRIwere excellent (intraclass correlation coefficient, .955; 95% confidence interval, .922-.974). In 28 patients (56%), Esimwas identical to DECEA. Mean DifferenceCEA-MRIwas 1.32 ± 1.77 mm. DifferenceCEA-MRIwas significantly greater with fibrotic plaque (4.14 ± 1.21 mm) than with lipid-rich or necrotic plaque (.43 ± .87 mm;P < .05) or hemorrhagic plaque (1.27 ± 1.64 mm;P < .05). Mean DifferenceCEA-MRIwas significantly greater in the group with tortuosity of the ICA less than 120° (3.86 ± 1.77 mm) than in the group with greater than or equal to 120° but less than or equal to 150° (1.15 ± 1.51 mm;P < .05) or greater than150° (0.50 ± 1.10 mm;P < .05). No patients showed residual stenosis after surgery on postoperative MR angiography.Conclusions:Using 3D-FSE T1-weighted MR plaque imaging allowed identification of the distal end of carotid plaque and contributed to complete removal of the plaque, although it may be reduced for cases with low-signal-intensity plaque or severe tortuosity of the ICA.