Quantifying Intracranial Plaque Permeability with Dynamic Contrast-Enhanced MRI: A Pilot Study.
Quantifying Intracranial Plaque Permeability with Dynamic Contrast-Enhanced MRI: A Pilot Study.
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DOI：
10.3174/ajnr.a4998
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发表时间：
2017-02
期刊：
影响因子：
--
通讯作者：
Ansari SA
中科院分区：
文献类型：
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作者：
Vakil P;Elmokadem AH;Syed FH;Cantrell CG;Dehkordi FH;Carroll TJ;Ansari SA
颅内动脉粥样硬化疾病斑块高强度和/或钆造影剂增强已被研究作为急性缺血性症状的成像生物标志物，使用单一静态MR成像测量。然而，对颅内斑块通透性动力学建模的价值还有待评估。本研究的目的是使用动态增强磁共振成像来量化有症状患者颅内动脉粥样硬化性疾病斑块的造影剂通透性，并将这些参数与使用黑血磁共振成像脉冲序列的现有斑块波动性标志物进行比较。我们进行了一项前瞻性研究，利用动态增强磁共振成像技术，研究了威氏环近端和远端主要颅内血管的造影剂摄取动力学，特别是在有症状的颅内动脉粥样硬化疾病患者中。利用改进的Tofts模型，我们从斑块增强曲线中提取了体积传递常数（Ktrans）和分数等离子体体积（Vp）参数。通过回归分析，我们将这些参数与症状发作时间以及斑块内高强度和T1 SPACE（黑血MR血管壁成像序列）的造影后增强进行了比较。我们对10例出现症状性颅内动脉粥样硬化性疾病的患者进行了分析。与健康白质相比，斑块中的Ktrans和Vp测量值更高，与脉络膜丛中的值相似或更低。只有Ktrans与症状出现时间显著相关（P = 0.02）。动态对比增强磁共振成像参数与斑块内增强或斑块内高强度无显著相关性（P = 0.4和P = 0.17）。与健康白质相比，颅内动脉粥样硬化斑块中Ktrans和Vp值升高提示动态增强磁共振成像是研究近端颅内血管壁和斑块特征的可行技术。Ktrans与症状发作之间的显著相关性在T1 space衍生指标上未被观察到，这表明Ktrans可能是颅内动脉粥样硬化斑块急性和症状相关病理变化的独立成像生物标志物。
Intracranial atherosclerotic disease plaque hyperintensity and/or gadolinium contrast enhancement have been studied as imaging biomarkers of acutely symptomatic ischemic presentations using single static MR imaging measurements. However, the value in modeling the dynamics of intracranial plaque permeability has yet to be evaluated. The purpose of this study was to use dynamic contrast-enhanced MR imaging to quantify the contrast permeability of intracranial atherosclerotic disease plaques in symptomatic patients and to compare these parameters against existing markers of plaque volatility using black-blood MR imaging pulse sequences. We performed a prospective study of contrast uptake dynamics in the major intracranial vessels proximal and immediately distal to the circle of Willis using dynamic contrast-enhanced MR imaging, specifically in patients with symptomatic intracranial atherosclerotic disease. Using the Modified Tofts model, we extracted the volume transfer constant (Ktrans) and fractional plasma volume (Vp) parameters from plaque-enhancement curves. Using regression analyses, we compared these parameters against time from symptom onset as well as intraplaque hyperintensity and postcontrast enhancement derived from T1 SPACE, a black-blood MR vessel wall imaging sequence. We completed analysis in 10 patients presenting with symptomatic intracranial atherosclerotic disease. Ktrans and Vp measurements were higher in plaques versus healthy white matter and similar or less than values in the choroid plexus. Only Ktrans correlated significantly with time from symptom onset (P = .02). Dynamic contrast-enhanced MR imaging parameters were not found to correlate significantly with intraplaque enhancement or intraplaque hyperintensity (P = .4 and P = .17, respectively). Elevated Ktrans and Vp values found in intracranial atherosclerotic disease plaques versus healthy white matter suggest that dynamic contrast-enhanced MR imaging is a feasible technique for studying vessel wall and plaque characteristics in the proximal intracranial vasculature. Significant correlations between Ktrans and symptom onset, which were not observed on T1 SPACE–derived metrics, suggest that Ktrans may be an independent imaging biomarker of acute and symptom-associated pathologic changes in intracranial atherosclerotic disease plaques.