Ipsilateral plaques display higher T1 signals than contralateral plaques in recently symptomatic patients with bilateral carotid intraplaque hemorrhage.
Ipsilateral plaques display higher T1 signals than contralateral plaques in recently symptomatic patients with bilateral carotid intraplaque hemorrhage.
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DOI：
10.1016/j.atherosclerosis.2017.01.001
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发表时间：
2017-02
期刊：
影响因子：
5.3
通讯作者：
CARE-II study investigators
中科院分区：
文献类型：
--
作者：
Wang X;Sun J;Zhao X;Hippe DS;Hatsukami TS;Liu J;Li R;Canton G;Song Y;Yuan C;CARE-II study investigators
前瞻性研究表明，磁共振成像（MRI）检测到的颈动脉斑块内出血（IPH）与脑血管缺血事件之间存在密切联系。然而，在大量无症状患者中也观察到IPH。我们假设与近期症状相关的IPH+斑块的特征与与近期症状无关的IPH+斑块相比存在差异。使用标准化多序列方案对近期（≤2周）发生前循环缺血事件的患者进行扫描。纳入双侧IPH患者，并分析同侧症状侧和对侧无症状侧之间T1/T2信号、斑块形态和共存斑块特征的差异。研究了31例双侧IPH受试者（67±9岁，97%为男性）。尽管管腔狭窄程度相当（53±42% vs. 53± 39%，p=0.99），与肌肉相比，IPH的T1信号（以信号强度比测量）更强（SIRIPH-肌肉：5.8±2.4 vs. 4.7±1.8，p=0.004），分布更广泛（IPH体积：150±199与88±106 mm 3，p=0.071）。与无症状侧相比，有症状侧的IPH+斑块更长（24±6 vs. 21±7 mm，p=0.026），并且与更大的坏死核心体积（406±354 vs. 291±293 mm 3，p=0.039）相关。在近期有症状的双侧颈动脉IPH患者中，有症状的一侧比无症状的一侧显示更强的T1信号，更大的坏死核心和更长的斑块长度。对这些影像学特征和临床事件之间的时间关系的系列研究将最终确立其诊断和预后价值，而不仅仅是IPH的存在。
Prospective studies have shown a strong association between carotid intraplaque hemorrhage (IPH), detected by magnetic resonance imaging (MRI), and cerebrovascular ischemic events. However, IPH is also observed in a substantial number of asymptomatic patients. We hypothesized that there are differences in the characteristics of IPH+ plaques associated with recent symptoms, compared to IPH+ plaques not associated with recent symptoms. Patients with recent (≤2 weeks) anterior circulation ischemic events were scanned using a standardized multisequence protocol. Those showing IPH bilaterally were included and analyzed for differences in T1/T2 signals, plaque morphology, and coexisting plaque characteristics between the ipsilateral symptomatic and contralateral asymptomatic sides. Thirty-one subjects (67±9 years, 97% males) with bilateral IPH were studied. Despite comparable luminal stenosis (53±42% vs. 53±39%, p=0.99), T1 signal of IPH measured as signal-intensity-ratio compared to muscle was stronger (SIRIPH-to-muscle: 5.8±2.4 vs. 4.7±1.8, p=0.004) and tended to be more extensively distributed (IPH volume: 150±199 vs. 88±106 mm3, p=0.071) on the symptomatic side. IPH+ plaques on the symptomatic side were longer (24±6 vs. 21±7 mm, p=0.026) and associated with larger necrotic core volume (406±354 vs. 291±293 mm3, p=0.039) than those on the asymptomatic side. In recently symptomatic patients with bilateral carotid IPH, the symptomatic side showed stronger T1 signals, larger necrotic cores, and longer plaque length than the asymptomatic side. Serial studies on the temporal relationship between these imaging features and clinical events will eventually establish their diagnostic and prognostic value beyond the mere presence of IPH.