Moderate Carotid Artery Stenosis: MR Imaging-depicted Intraplaque Hemorrhage Predicts Risk of Cerebrovascular Ischemic Events in Asymptomatic Men
Moderate Carotid Artery Stenosis: MR Imaging-depicted Intraplaque Hemorrhage Predicts Risk of Cerebrovascular Ischemic Events in Asymptomatic Men
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DOI：
10.1148/radiol.2522080792
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发表时间：
2009-08-01
期刊：
影响因子：
19.7
通讯作者：
Maggisano, Robert
中科院分区：
文献类型：
--
作者：
Singh, Navneet;Moody, Alan R.;Maggisano, Robert
目的：通过快速三维t1加权脂肪抑制破坏梯度回声序列研究无症状中度颈动脉狭窄男性颈动脉壁斑块内出血（IPH）与未来同侧脑血管事件风险之间的关系。材料和方法：机构伦理审查委员会批准了这项回顾性图表审查，并放弃了书面知情同意的要求。所有患者均在随访电话访谈中给予口头知情同意。回顾性分析了2003年至2006年间在血管诊所就诊的91名无症状颈动脉狭窄（多普勒超声检查为50%-70%）并接受磁共振成像检测IPH的男性（平均年龄74.8岁，范围47-88岁）。有98条符合条件的颈动脉的75名男性被纳入研究。患者至少随访1年（平均随访24.92个月，范围12-43个月）。Kaplan-Meier生存期和单变量Cox回归分析比较有和没有磁共振成像IPH的颈动脉未来同侧脑血管事件发生率。结果：在纳入的98条颈动脉中，36条（36.7%）有mr描述的IPH。有IPH的颈动脉发生6例脑血管事件（2例中风和4例短暂性脑缺血发作），而无IPH的颈动脉无临床事件。单因素Cox回归分析证实mr描述的IPH与脑血管事件风险增加相关（风险比为3.59；95%可信区间为2.48,4.71;P < 0.001）。mr描述的IPH阴性预测结果（阴性预测值= 100%）。结论：在这个无症状的中度颈动脉狭窄的队列中，mr描述的IPH与未来的同侧脑血管事件相关。相反，没有磁共振成像的IPH患者在随访期间仍然无症状。因此，磁共振成像中IPH的缺失可能是斑块稳定性和血栓栓塞风险较低的可靠标志。(c) rsna， 2009年
Purpose: To investigate the association between magnetic resonance (MR) imaging-depicted intraplaque hemorrhage (IPH) in the carotid artery wall and the risk of future ipsilateral cerebrovascular events in men with asymptomatic moderate carotid stenosis by using a rapid three-dimensional T1-weighted fat-suppressed spoiled gradient-echo sequence.Materials and Methods: The institutional ethics review board approved this retrospective chart review and waived the requirement for written informed consent. All patients gave informed verbal consent at follow-up telephone interviews. Ninety-one men (mean age, 74.8 years; range, 47-88 years) who attended a vascular clinic between 2003 and 2006, who had asymptomatic carotid stenosis (50%-70% at Doppler ultrasonography), and who had undergone MR imaging for IPH detection were retrospectively identified. Seventy-five men with 98 eligible carotid arteries were included in the study. Patients were followed for a minimum of 1 year (mean follow-up, 24.92 months; range, 12-43 months). Kaplan-Meier survival and univariate Cox regression analyses were conducted to compare future ipsilateral cerebrovascular event rates between carotid arteries with and those without MR-depicted IPH.Results: Of the 98 carotid arteries included, 36 (36.7%) had MR-depicted IPH. Six cerebrovascular events (two strokes and four transient ischemic attacks) occurred in the carotid arteries with IPH, as compared with no clinical events in the carotid arteries without IPH. Univariate Cox regression analysis confirmed that MR-depicted IPH was associated with an increased risk of cerebrovascular events (hazard ratio, 3.59; 95% confidence interval: 2.48, 4.71; P < .001). MR-depicted IPH negatively predicted outcomes (negative predictive value = 100%).Conclusion: In this cohort with asymptomatic moderate carotid stenosis, MR-depicted IPH was associated with future ipsilateral cerebrovascular events. Conversely, patients without MR-depicted IPH remained asymptomatic during follow-up. The absence of IPH at MR imaging, therefore, may be a reassuring marker of plaque stability and of a lower risk of thromboembolism. (C) RSNA, 2009