目的 基于高分辨磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI)分析颈动脉斑块的特征并进行斑块影像报告与数据系统(Plaque Reporting And Data System,Plaque-RADS)评分,探究Plaque-RADS评分的临床应用价值.材料与方法 回顾性收集2022年1月至2023年12月行HRMR-VWI的患者85例,其中梗死组33例,非梗死组52例,采用独立样本t检验或Mann-Whitney U检验,比较责任斑块与非责任斑块的各项参数,并对斑块进行Plaque-RADS评分,通过logistic回归分析筛选斑块的独立危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估各参数的诊断效能.结果 梗死组中责任斑块33个,非责任斑块29个,非梗死组中非责任斑块102个.责任斑块的最小管腔面积、纤维化组织体积占比明显小于非责任斑块(P<0.05);责任斑块的长度、斑块体积、平均管壁厚度、最小管壁厚度、最大管壁厚度、重构指数、斑块内出血(intraplaque hemorrhage,IPH)或血栓体积、IPH或血栓体积占比明显大于非责任斑块(P<0.05);与非责任斑块相比,责任斑块的斑块负荷、狭窄度、Plaque-RADS评分更大(P<0.001).logistic回归分析显示,斑块的长度[比值比(odds ratio,OR)=1.67,95%置信区间(confidence interval,CI):1.04～1.10]、斑块负荷(OR=3.57,95%CI:1.76～7.24)、重构指数(OR=3.26,95%CI:1.62～6.59)IPH或血栓(OR=5.33,95%CI:2.27～12.52)、Plaque-RADS评分(OR=4.66,95%CI:2.35～9.24)、狭窄度(OR=3.77,95%CI:1.98～7.15),以及平均管壁厚度(OR=2.13,95%CI:1.05～4.32)为发生急性脑梗死(acute cerebral infarction,ACI)的重要风险因素;Plaque-RADS评分预测ACI的曲线下面积(area under the curve,AUC)为 0.815(95%CI:0.732～0.898),Plaque-RADS评分联合其余各项危险因素预测ACI的AUC为0.837(95%CI:0.735～0.921).结论 颈动脉斑块存在IPH或血栓,以及斑块长度、斑块负荷、重构指数、管腔狭窄度、平均管壁厚度、Plaque-RADS评分增加,均会增加同侧发生ACI发生的风险;Plaque-RADS评分可标准化评估颈动脉斑块,提示斑块的危险分层,识别出高风险患者,是发生同侧ACI的有效预测指标.
Analysis of the characteristics of carotid plaque based on HRMR-VWI and the clinical application value of Plague-RADS score
Objective:This study utilizes high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)to analyze the characteristics of carotid atherosclerotic plaques,and Plaque Reporting and Data System(Plaque-RADS)scoring system were performed to explore the clinical value of Plaque-RADS.Materials and Methods:A retrospective collection of 85 patients who underwent HRMR-VWI from January 2022 to December 2023 was analyzed.This cohort included 33 patients in the stroke group and 52 patients in the non-stroke group.Independent sample t-tests or Mann-Whitney U tests were used to compare parameters between culprit and non-culprit plaques.logistic regression analysis identified independent risk factors for plaque characteristics,and receiver operating characteristic(ROC)curves were used to assess the diagnostic efficiency of these parameters.Results:There were 33 culprit and 29 non-culprit plaques in the stroke group,while 102 non-culprit plaques in the non-stroke group.Culprit plaques had significantly smaller minimum lumen area and a lower percentage of fibrous tissue volume(P<0.05);They also exhibited greater plaque length,volume,average wall thickness,minimum and maximum wall thickness,remodeling index,and volume of intraplaque hemorrhage(IPH)or thrombus(P<0.05)compared to non-culprit plaques.Furthermore,compared to non-culprit plaques,culprit lesions had higher plaque burden,degree of stenosis,and Plaque-RADS scores(P<0.001).Logistic regression revealed that plaque length[odds ratio(OR)=1.67,95%confidence interval(CI):1.04-1.10)],plaque burden(OR=3.57,95%CI:1.76-7.24),remodeling index(OR=3.26,95%CI:1.62-6.59),presence of IPH or thrombus(OR=5.33,95%CI:2.27-12.52),and Plaque-RADS score(OR=4.66,95%CI:2.35-9.24),among others,were significant risk factors for ipsilateral acute cerebral infarction(ACI).The area under the curve(AUC)for Plaque-RADS scoring alone was 0.815(95%CI:0.732-0.898),and combining it with other risk factors yielded an AUC of 0.837(95%CI:0.735-0.921).Conclusions:Carotid plaques with IPH or thrombus,increased plaque length,burden,remodeling index,degree of stenosis,average wall thickness,and higher Plaque-RADS scores significantly elevate the risk of ipsilateral ACI.The Plaque-RADS score provides a standardized evaluation of carotid plaques,indicating the risk stratification and identifying high-risk patients,thus serving as an effective predictor of ACI.This study underscores the value of Plaque-RADS in enhancing clinical decision-making and improving outcomes for patients with carotid atherosclerosis.
carotid atherosclerotic plaqueacute cerebral infarctionmagnetic resonance imaginghigh-resolution magnetic resonance vessel wall imagingPlaque Reporting and Data System
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