A noninvasive imaging approach to assess plaque severity: the carotid atherosclerosis score.
A noninvasive imaging approach to assess plaque severity: the carotid atherosclerosis score.
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DOI：
10.3174/ajnr.a2007
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发表时间：
2010-06
期刊：
影响因子：
--
通讯作者：
Yuan C
中科院分区：
文献类型：
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作者：
Underhill HR;Hatsukami TS;Cai J;Yu W;DeMarco JK;Polissar NL;Ota H;Zhao X;Dong L;Oikawa M;Yuan C
颈动脉粥样硬化斑块中 IPH 和/或 FCR 的存在表明存在高风险病变。这项多中心横断面研究的目的是确定 IPH 和/或 FCR 之前可能发生的病变特征。我们进一步寻求构建一个对颈动脉疾病严重程度进行分层的 CAS。来自 4 个成像中心的 344 名患者通过双功超声检查发现颈动脉狭窄 16%–99%，接受了颈动脉 MR 成像。在大约 60% 的研究样本（训练组）中，使用多变量分析来确定与 IPH 和 FCR 相关的因素。多变量分析期间确定的具有统计学意义的参数用于构建 CAS。然后将 CAS 应用于剩余动脉（40%，测试组），并通过 ROC 分析和 AUC 计算来确定确定是否存在 IPH 或单独 FCR 的分类准确性。在训练组的多变量分析中，LRNC 占据的动脉壁最大比例是 IPH (P < .001) 和 FCR (P < .001) 的最强预测因子。随后得出的应用于测试组的 CAS 是 IPH（AUC = 0.91）和 FCR（AUC = 0.93）的准确分类器。与 MRA 狭窄相比，CAS 对 IPH 和 FCR 的分类能力更强。 LRNC 量化可能是对颈动脉狭窄进行分类颈动脉粥样硬化疾病严重程度的有效补充策略。 CAS 为颈动脉中基于成像的简单风险分层系统奠定了基础，用于对动脉粥样硬化疾病的严重程度进行分类。
The presence of IPH and/or FCR in the carotid atherosclerotic plaque indicates a high-risk lesion. The aim of this multicenter cross-sectional study was to establish the characteristics of lesions that may precede IPH and/or FCR. We further sought to construct a CAS that stratifies carotid disease severity. Three hundred forty-four individuals from 4 imaging centers with 16%– 99% carotid stenosis by duplex sonography underwent carotid MR imaging. In approximately 60% of the study sample (training group), multivariate analysis was used to determine factors associated with IPH and FCR. Statistically significant parameters identified during multivariate analysis were used to construct CAS. CAS was then applied to the remaining arteries (40%, test group), and the accuracy of classification for determining the presence versus absence of IPH or, separately, FCR was determined by ROC analysis and calculation of the AUC. The maximum proportion of the arterial wall occupied by the LRNC was the strongest predictor of IPH (P < .001) and FCR (P < .001) during multivariate analysis of the training group. The subsequently derived CAS applied to the test group was an accurate classifier of IPH (AUC = 0.91) and FCR (AUC = 0.93). Compared with MRA stenosis, CAS was a stronger classifier of both IPH and FCR. LRNC quantification may be an effective complementary strategy to stenosis for classifying carotid atherosclerotic disease severity. CAS forms the foundation for a simple imaging-based risk-stratification system in the carotid artery to classify severity of atherosclerotic disease.