基于MRI的颈动脉易损斑块与脑白质高信号的相关性研究
Research on the correlation between vulnerable carotid artery plaques and brain white matter hyperinten-sity based on MRI
朱雨蒙 1朱丽平 1葛学 1张生 1胡春峰 1马红1
作者信息
- 1. 221000 江苏徐州,徐州医科大学附属医院放射科
- 折叠
摘要
目的:基于MRI探讨颈动脉易损斑块与脑白质高信号(WMH)的相关性.方法:回顾性搜集2018年11月-2022年10月在本院经超声或CTA检出颈动脉斑块的93例患者的临床及影像资料.所有患者于2周内行常规颅脑MRI平扫(T1WI、T2WI、T2-FLAIR、DWI)及颈动脉高分辨率MRI扫描(3D-TOF、T1WI、T2WI、CE-MRA及对比增强3D-T1WI).根据颅脑MRI影像表现,采用Fazekas量表对 WMH进行评分,0～2分为 WMH轻度组(n=57),3～6分为 WMH中重度组(n=36).基于颈动脉高分辨率M RI对斑块的特征进行分析并判断斑块的性质(易损/稳定斑块),易损斑块的特征包括斑块内出血(IPH)、脂质坏死核心(LRNC)、纤维帽薄或破裂(TRFC)及斑块表面钙化.搜集患者的年龄、性别、高血压病史及实验室检查结果等临床资料.对临床资料和斑块性质进行组间比较,将组间差异有统计学意义的变量纳入多因素logistic回归分析,确定脑白质高信号的独立危险因素.最后,采用卡方检验分析易损斑块组内斑块特征在WMH轻度组与中重度组之间的差异.结果:单因素分析结果显示,WMH中重度组的年龄和易损斑块的占比均高于WMH轻度组,差异有统计学意义(P＜0.001和P=0.004).多因素logistic回归分析显示,在校正性别、高血压史和糖尿病史后,年龄≥ 60岁(OR=4.049,95％CI:1.441～11.380,P=0.008)和颈动脉易损斑块(OR=3.935,95％CI:1.321～11.728,P=0.014)是中重度 WMH的独立危险因素.易损斑块内出血(IPH)的发生率在 WMH轻度组与WMH中重度组间的差异有统计学意义(P＜0.05).结论:颈动脉易损斑块是影响WMH的独立危险因素,在易损斑块中颈动脉IPH与WMH严重程度显著相关.
Abstract
Objective:The purpose of this study was to investigate the correlation between vul-nerable carotid plaques and brain white matter hyperintensity(WMH)based on MRI.Methods:The clinical and imaging data of 93 patients with carotid artery plaques detected by ultrasound or CTA in our hospital from November 2018 to October 2022 was studied retrospectively.All patients underwent routine brain MRI plain scan(T1 WI,T2 WI,T2-FLAIR and DWI)and high-resolution carotid artery MRI scan[sequences mainly including 3D-TOF,T1 WI,T2 WI,CE-MRA and CE 3D-T1WI]within 2 weeks.According to the imaging findings of the brain MRI,the Fazekas scale was used for scoring(0～6 points),and patients with 0～2 points were classified as mild WMH(mWMH)group(n=57),and patients with 3～6 points were classified as moderate to severe WMH(msWMH)group(n=36).The features of plaque were analyzed based on high-resolution MRI of the carotid artery for identifying the plaque stability.The features of vulnerable plaque included intra plaque hemorrhage(IPH),lipid nec-rotic core(LRNC),thin or ruptured fibrous cap(TRFC),and plaque surface calcification.The clinical data such as age,gender,history of hypertension,and laboratory test results of each patient were col-lected.The clinical data and plaque stability between the two groups were compared,and the variables with statistically significant difference was included in multivariate logistic regression analysis to find out the independent risk factors for white matter hyper-intensity.Finally,within the vulnerable plaque group,chi-square test was used to analyze the difference in plaque features between the mWMH group and msWMH group.Results:The results of univariate analysis showed that significant difference was found in age(P＜0.001)and vulnerable plaque proportion(P=0.004)between mWMH group and msWMH group,patients in the msWMH group had a higher age and proportion of vulnerable plaque than those in the mWMH group.Multivariate logistic regression analysis showed that age ≥60 years(OR=4.049,95％CI:1.441～11.380,P=0.008)and vulnerable carotid plaque(OR=3.935,95％CI:1.321～11.728,P=0.014)were independent risk factors for moderate to severe WMH after adjusting by gender,hypertension history,and diabetes history.The incidence of intra plaque hemorrhage(IPH)showed a statistically significant difference between the mWMH group and msWMH groups(P＜0.05).Conclusion:Carotid artery vulnerable plaques are independent risk factors affecting WMH,and a-mong vulnerable plaques,carotid artery IPH is significantly correlated with the severity of WMH.
关键词
易损斑块/脑白质高信号/磁共振血管壁成像/脑小血管病/危险因素Key words
Vulnerable plaque/White matter hyperintensity/High-resolution magnetic reso-nance imaging/Cerebral small vessel diseases/Risk factors引用本文复制引用
出版年
2024
NETL
NSTL
万方数据