Carotid Intraplaque Hemorrhage: MRI of Therapeutic Response and Clinical Sequelae

摘要 磁共振成像(Mri)是一种成熟的技术，可以非侵入性地识别关键的病变。 颈动脉粥样硬化的特点。先前的MRI研究表明，颈动脉斑块内出血(IPH) 管腔表面破坏与未来缺血事件的风险增加相关，IPH是 与更快的斑块进展和更大的炎症活动和 新生血管。 在我们目前的队列研究中，我们测试了这样的假设，尽管他汀类药物治疗和积极的调节 合并IPH的颈动脉病变血压、稳定性受损。到目前为止的发现支持我们最初的 假设。此外，对我们数据的初步中期分析提示潜在的危险因素和核磁共振信号。 与IPH进展相关的特征。然而，较长期的随访对于 证实了这些有希望的初步发现。 这种竞争性更新的中心假设是：i)血液动力学因素和斑块增加 新生血管与新的或重复的IPH的发展有关，以及ii)斑块的发生率 进程是由重复的IPH驱动的，这可以通过MR T1和T2映射来表征--一种定量的 评估IPH消退和复发的方法。 我们研究的长期目标是在前瞻性的临床研究中利用磁共振成像来洞察 高危颈动脉斑块的发病机制，以确定与进展更快相关的危险因素， 最终，建立颈动脉斑块成像作为减少卒中发生率的临床诊断工具。 在全球范围内，中风仍然是导致严重长期残疾和死亡的主要原因之一，并导致颈动脉 动脉粥样硬化是一个重要的因素。迫切需要对其发病机制有更好的了解 开发更有效的一级和二级卒中预防方法。

Abstract Magnetic resonance imaging (MRI) is a proven technique that can non-invasively identify key pathological features of carotid atherosclerosis. Prior MRI studies have shown that carotid intraplaque hemorrhage (IPH) and lumen surface disruption are associated with increased risk for future ischemic events, and that IPH is associated with more rapid plaque progression and presence of greater inflammatory activity and neovascularization. In our current cohort study, we tested the hypothesis that despite statin therapy and aggressive regulation of blood pressure, stability of carotid lesions with IPH is compromised. Findings to date support our original hypothesis. Further, preliminary interim analysis of our data suggest potential risk factors and MRI signal characteristics that are associated with the progression of IPH. However, longer-term follow-up is critical to confirm these promising initial findings. The central hypotheses of this competing renewal are that i) hemodynamic factors and increased plaque neovascularization are associated with the development of new or repeated IPH, and ii) the rate of plaque progression is driven by repeated IPH that can be characterized by MR T1 and T2 mapping -- a quantitative means to assess IPH resolution and recurrence. The long-term goals of our research is to utilize MRI in prospective clinical studies to gain insight into the pathogenesis of the high-risk carotid plaque, to identify risk factors associated with more rapid progression, and ultimately, to establish carotid plaque imaging as a clinical diagnostic tool for reduction of incident stroke. Globally, stroke remains one of the leading causes of serious long-term disability and mortality and carotid atherosclerosis is a significant contributor. A better understanding of its pathogenesis is critically needed to develop more effective methods for primary and secondary stroke prevention.