Non-invasive imaging of carotid arterial restenosis using 3T cardiovascular magnetic resonance.
Non-invasive imaging of carotid arterial restenosis using 3T cardiovascular magnetic resonance.
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DOI：
10.1186/1532-429x-16-5
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发表时间：
2014-01-08
期刊：
影响因子：
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通讯作者：
Choudhury RP
中科院分区：
文献类型：
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作者：
Lindsay AC;Biasiolli L;Knight S;Cunnington C;Robson MD;Neubauer S;Kennedy J;Handa A;Choudhury RP
颈动脉内膜切除术后颈动脉再狭窄是常见的，但对病变成分的分析主要是基于对再狭窄病变的组织学研究。本研究调查了3 T心血管磁共振（CMR）确定颈动脉疾病复发的成分的能力，并检查这些成分是否与原发性动脉粥样硬化斑块不同。50例患者使用标准多重对比方案进行双侧颈动脉的3 T CMR：飞行时间（TOF）、T1加权（T1 W）、T2加权（T2 W）和PD加权（PDW）涡轮自旋回波（TSE）序列。25例患者既往接受过颈动脉内膜切除术（手术后平均时间1580天，范围45-6560天），25例原发性无症状动脉粥样硬化斑块患者作为对照。两名经验丰富的评审员根据是否存在主要斑块特征分析了多重对比CMR图像，并分配了总体分类类型。在动脉内膜切除术后复发性颈动脉疾病的患者中，平均再狭窄程度为51%（范围30-90%）。确定了三种不同类型的再狭窄：5例患者（20%）显示出纤维动脉粥样硬化组织的CMR特征，11例患者（44%）具有与可能的肌内膜（纤维肌性）增生一致的斑块特征，6例患者（24%）具有提示进一步脂质积聚的复发性斑块。3例患者（12%）显示术后颈动脉内膜夹层的证据。与原发性动脉粥样硬化斑块相比，再狭窄斑块更可能含有纤维粥样硬化组织（p = 0.05）和平滑肌（p < 0.01），而不太可能含有脂质（p < 0.01）。早期和晚期再狭窄患者的成分无显著差异。根据CMR的定义，颈动脉再狭窄病变分为三种不同类型，其组成与原发性动脉粥样硬化斑块不同。如果通过随后的组织学研究证实，这些发现可能表明CMR在检测高风险（即富含脂质）再狭窄病变中的作用。
Restenosis of the carotid artery is common following carotid endarterectomy, but analysis of lesion composition has mostly been based on histological study of explanted restenotic lesions. This study investigated the ability of 3T cardiovascular magnetic resonance (CMR) to determine the components of recurrent carotid artery disease and examined whether these differed from primary atherosclerotic plaque. 50 patients underwent 3T CMR of both carotid arteries using a standard multicontrast protocol: time-of-flight (TOF), T1-weighted (T1W), T2-weighted (T2W), and PD-weighted (PDW) Turbo-Spin-Echo (TSE) sequences. 25 patients had previously undergone carotid endarterectomy (mean time since surgery 1580 days, range 45–6560 days), and 25 with primary asymptomatic atherosclerotic plaques served as controls. Two experienced reviewers analysed the multicontrast CMR images according to the presence or absence of major plaque features and assigned an overall classification type. In patients with recurrent carotid disease following endarterectomy, the mean degree of restenosis was 51% (range 30–90%). Three distinct types of restenosis were identified: 5 patients (20%) showed CMR characteristics of fibro-atheromatous tissue, 11 patients (44%) had plaque features consistent with possible myointimal (fibromuscular) hyperplasia, and 6 patients (24%) had recurrent plaque suggestive of further lipid accumulation. Three patients (12%) showed evidence of post-surgical dissection of the carotid intima. Compared to primary atherosclerotic plaques, restenotic plaques were more likely to contain fibro-atheromatous tissue (p = 0.05) and smooth muscle (p < 0.01), and less likely to contain lipid (p < 0.01). Composition did not differ significantly between patients with early and late restenosis. As defined by CMR, restenotic lesions of the carotid artery fall into three distinct types and differ in composition from primary atherosclerotic plaques. If validated by subsequent histological studies, these findings could suggest a role for CMR in detecting high-risk (i.e. lipid-rich) restenotic lesions.