Intracranial Plaque Characterization in Patients with Acute Ischemic Stroke Using Pre- and Post-Contrast Three-Dimensional Magnetic Resonance Vessel Wall Imaging
Intracranial Plaque Characterization in Patients with Acute Ischemic Stroke Using Pre- and Post-Contrast Three-Dimensional Magnetic Resonance Vessel Wall Imaging
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DOI：
10.1016/j.jstrokecerebrovasdis.2015.12.032
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发表时间：
2016-06-01
影响因子：
2.5
通讯作者：
Terayama, Yasuo
中科院分区：
文献类型：
--
作者：
Natori, Tatsunori;Sasaki, Makoto;Terayama, Yasuo
背景资料：磁共振血管壁成像（VWI）技术已被开发用于评估颅内动脉粥样硬化斑块，这是缺血性卒中的主要原因。然而，斑块相关的脆弱性和炎症的临床作用仍不清楚。因此，我们评估了急性缺血性卒中患者大脑中动脉（M1）近端VWI的斑块特征。研究方法：我们前瞻性地检查了30例连续的M1区急性非心源性卒中患者，使用3特斯拉扫描仪进行对比前后T1加权（T1 W）三维（3D）VWI。在双侧M1测量斑块的对比度（CR）和对比增强。结果：所有患者双侧M1段均有斑块形成，无明显狭窄。梗死同侧M1斑块的CR率（46.7%-67.9%）显著高于对侧斑块的CR率（34.3%-69.4%），尤其是腔隙性梗死患者（P <0.01）。相反，斑块强化的发生率在同侧（20.0%）和对侧（16.7%）之间没有差异。此外，无腔隙组的CR显著高于腔隙组的CR（P <0.05），而强化斑块在无腔隙组中更常见，但差异不显著（P = 0.09）。结论：T1 W3 D-VWI显示急性脑卒中患者患侧和非腔隙性梗死的M1斑块信号强度明显较高，表明M1不稳定斑块可能导致脑卒中事件，推测其可能是由于动脉粥样硬化血栓形成机制。(C)2016年全国中风协会。爱思唯尔公司出版All rights reserved.
Background: Magnetic resonance vessel wall imaging (VWI) techniques have been developed to assess atherosclerotic plaques in intracranial arteries, which are a cardinal cause of ischemic stroke. However, the clinical roles of plaque-related vulnerability and inflammation remain unclear. Hence, we evaluated plaque characteristics using VWI of the proximal middle cerebral artery (M1) in patients with acute ischemic stroke. Methods: We prospectively examined 30 consecutive patients with acute noncardioembolic stroke in the M1 territory using pre-/postcontrast T1-weighted (T1W) three-dimensional (3D) VWI with a 3-Tesla scanner. The contrast ratio (CR) and contrast enhancement of the plaques were measured bilaterally at M1. Results: Plaques were identified in the bilateral M1s of all patients, and no substantial stenosis existed. The M1 plaque CRs ipsilateral to the infarct (46.7%-67.9%) were significantly higher than the plaque CRs on the contralateral side (34.3%-69.4%), particularly in patients with lacunar infarcts (P < .01). In contrast, the occurrence of plaque enhancement was not different between the ipsilateral (20.0%) and contralateral (16.7%) sides. Further, the CRs in the nonlacunar group were significantly higher than the CRs in the lacunar group (P < .05), whereas enhanced plaques tended to be more frequent in the nonlacunar group, but this difference was not significant (P = .09). Conclusions: T1W 3D-VWI revealed that the signal intensity of M1 plaques was significantly higher in the affected side and in nonlacunar-type infarcts of patients with acute stroke, suggesting that unstable plaques in the M1 can cause stroke events presumably due to atherothrombotic mechanisms. (C) 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.