Adventitial perfusion and intraplaque hemorrhage: a dynamic contrast-enhanced MRI study in the carotid artery.
Adventitial perfusion and intraplaque hemorrhage: a dynamic contrast-enhanced MRI study in the carotid artery.
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DOI：
10.1161/strokeaha.111.000435
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发表时间：
2013-04
期刊：
影响因子：
8.3
通讯作者：
Yuan C
中科院分区：
文献类型：
--
作者：
Sun J;Song Y;Chen H;Kerwin WS;Hippe DS;Dong L;Chen M;Zhou C;Hatsukami TS;Yuan C
解剖研究表明斑块内出血（IPH）和血管血管之间的关系，血管血管主要来自外膜。颈动脉外血管可以通过动态增强MRI评估灌注参数来表征。本研究的目的是使用动态增强MRI在临床人群体内检测血管外灌注是否与IPH相关，血管外灌注指示血管微结构。有症状的颈动脉斑块同侧缺血事件患者行双侧颈动脉MRI检查，包括检测IPH的多造影序列和表征动脉外灌注的动态增强MRI序列。对动态增强MRI时间序列进行动力学建模，以估计体外vp（血浆体积分数，反映局部血液供应）和Ktrans（传递常数，反映血管表面积和通透性）。从招募的27例患者（22例男性，69±10岁）中，获得了50条动脉的血管外灌注参数。IPH的存在与前期Ktrans值显著升高相关（0.142±0.042 vs 0.112±0.029 min - 1， P<0.001），但与vp值无关（0.163±0.064 vs 0.149±0.062，P=0.338）。在调整了症状状态、狭窄程度和其他混杂因素后，这种关系仍然存在。本研究表明外膜与IPH之间存在独立的病理生理联系，并将其与外膜血管的微观结构联系起来。血管外灌注成像可能有助于研究斑块的发病机制，但需要进一步的前瞻性研究。
Autopsy studies have suggested a relationship between intraplaque hemorrhage (IPH) and vasa vasorum, which arise primarily from the adventitia. Adventitial vasa vasorum can be characterized in the carotid arteries by estimating perfusion parameters via dynamic contrast-enhanced MRI. The purpose of this investigation was to use dynamic contrast-enhanced MRI to test in vivo in a clinical population whether adventitial perfusion, indicative of vasa vasorum microstructure, is associated with IPH. Symptomatic patients with carotid plaque ipsilateral to the ischemic event underwent bilateral carotid artery MRI examination, which included multicontrast sequences for detecting IPH and a dynamic contrast-enhanced MRI sequence for characterizing adventitial perfusion. Kinetic modeling of the dynamic contrast-enhanced MRI time series was performed to estimate adventitial vp (fractional plasma volume, reflecting local blood supply) and Ktrans (transfer constant, reflecting vessel surface area, and permeability). From the 27 patients (22 men; 69±10 years of age) recruited, adventitial perfusion parameters were obtained in 50 arteries. The presence of IPH was associated with a significantly higher value in adventitial Ktrans (0.142±0.042 vs 0.112±0.029 min−1; P<0.001) but not in vp (0.163±0.064 vs 0.149±0.062; P=0.338). This relationship remained after adjusting for symptomatic status, degree of stenosis, and other confounding factors. This study demonstrated an independent pathophysiological link between the adventitia and IPH and related it to the microstructure of adventitial vasa vasorum. Adventitial perfusion imaging may be useful in studying plaque pathogenesis, but further examination through prospective studies is needed.