MRI Plaque Imaging Detects Carotid Plaques with a High Risk for Future Cerebrovascular Events in Asymptomatic Patients
MRI Plaque Imaging Detects Carotid Plaques with a High Risk for Future Cerebrovascular Events in Asymptomatic Patients
复制标题
MRI 斑块成像可检测无症状患者未来发生脑血管事件的高风险颈动脉斑块
作者：
L. Esposito;T. Saam;Iman Ghodrati;J. Pelisek;P. Heider;Matthias Bauer;Petra Wolf;A. Bockelbrink;R. Feurer;D. Sepp;C. Winkler;P. Zepper;T. Boeckh;M. Riemenschneider;B. Hemmer;H. Poppert
目的：本研究的目的是前瞻性地调查MRI斑块成像是否可以识别无症状颈动脉狭窄患者，这些患者未来发生脑事件的风险增加。MRI斑块成像允许将颈动脉狭窄分类为不同的病变类型（I-VIII）。在这些病变类型中，IV-V型和VI型病变被认为是易破裂斑块，而其他病变类型代表稳定斑块。方法83例连续患者（45例男性（54.2%）;年龄54-88岁（平均73.2岁）），根据ECST标准，无症状颈动脉狭窄50-99%。患者使用1.5 T扫描仪进行成像。进行了T1、T2、飞行时间和质子密度加权研究。颈动脉斑块被归类为病变类型I-VIII。临床终点为缺血性卒中、TIA或一过性黑蒙。生存分析和对数秩检验用于确定统计学意义。结果83例患者中有6例（7.2%）被排除：4例患者的MRI图像质量不足; 1例患者失访; 1例患者在基线MRI斑块成像后不久死亡。通过分析其余77例患者获得以下结果。平均随访时间为41.1个月。随访期间，n = 9（11.7%）例发生同侧缺血性脑血管事件。 仅存在高风险病变类型IV-V和VI的患者发生同侧脑血管事件，而存在稳定病变类型III、VII和VIII的患者均未发生同侧脑血管事件（随访期间n= 9（11.7%）vs. n =0（0%））。 MRI定义的稳定病变类型（III、VII和VIII）患者的无事件生存率高于高危病变类型（IV-V和VI）患者（对数秩检验P<0.0001）。结论MRI斑块成像有可能识别无症状颈动脉狭窄患者，这些患者特别有发生未来脑缺血的风险。MRI可以改善未来侵入性治疗的选择标准。
Purpose The aim of this study was to investigate prospectively whether MRI plaque imaging can identify patients with asymptomatic carotid artery stenosis who have an increased risk for future cerebral events. MRI plaque imaging allows categorization of carotid stenosis into different lesion types (I–VIII). Within these lesion types, lesion types IV–V and VI are regarded as rupture-prone plaques, whereas the other lesion types represent stable ones. Methods Eighty-three consecutive patients (45 male (54.2%); age 54–88 years (mean 73.2 years)) presenting with an asymptomatic carotid stenosis of 50–99% according to ECST-criteria were recruited. Patients were imaged with a 1.5-T scanner. T1-, T2-, time-of-flight-, and proton-density weighted studies were performed. The carotid plaques were classified as lesion type I–VIII. Clinical endpoints were ischemic stroke, TIA or amaurosis fugax. Survival analysis and log rank test were used to ascertain statistical significance. Results Six out of 83 patients (7.2%) were excluded: 4 patients had insufficient MR image quality; 1 patient was lost-to-follow-up; 1 patient died shortly after the baseline MRI plaque imaging. The following results were obtained by analyzing the remaining 77 patients. The mean time of follow-up was 41.1 months. During follow-up, n = 9 (11.7%) ipsilateral ischemic cerebrovascular events occurred. Only patients presenting with the high-risk lesion types IV–V and VI developed an ipsilateral cerebrovascular event versus none of the patients presenting with the stable lesion types III, VII, and VIII (n = 9 (11.7%) vs. n = 0 (0%) during follow-up). Event-free survival was higher among patients with the MRI-defined stable lesion types (III, VII, and VIII) than in patients with the high-risk lesion types (IV–V and VI) (log rank test P<0.0001). Conclusions MRI plaque imaging has the potential to identify patients with asymptomatic carotid stenosis who are particularly at risk of developing future cerebral ischemia. MRI could improve selection criteria for invasive therapy in the future.
DOI：
10.2217/iim.09.33
发表时间：
2010-02-01
期刊：
Imaging in medicine
影响因子：
--
作者：
Hatsukami TS;Yuan C
通讯作者：
Yuan C
影响因子：
4.3
作者：
Carr, S;Farb, A;Yao, JST
通讯作者：
Yao, JST