论文部分内容阅读
目的应用高分辨磁共振成像技术评估轻中度狭窄的颈动脉血管重构模式,探讨血管重构模式与颈动脉斑块在缺血性脑卒中事件发生、发展中的关系。方法纳入经超声诊断颈动脉粥样硬化,且斑块≥2 mm发生急性缺血性脑梗死或短暂性脑缺血的患者32例,进行高分辨磁共振斑块成像。根据斑块的信号、表面纤维帽的完整性判定斑块的稳定情况;同时测量斑块最厚层面、远端及近端参考点的总管腔、管壁面积,计算出管壁标准化指数、重构指数(remodeling index,RI)、斑块负荷及斑块大小。RI≥1.05为正性重构(positive remodeling,PR),RI<1.05为非正性重构(non-positive remodeling,nonPR)。比较PR组与Non-PR组测量指标的差异,并对重构模式与斑块易损性进行相关性分析。结果共检出55个颈动脉斑块,PR组与Non-PR组在总管腔、管壁面积、管壁标准化指数上差异无统计学意义(P>0.05),两组斑块负荷及斑块大小差异有统计学意义(P<0.001)。重构模式与斑块易损性的相关性分析差异无统计学意义(χ~2=0.532,P>0.05)。结论轻中度血管狭窄早期以PR为主,重构模式与斑块的易损性无正性相关,斑块自身成分的变化是导致缺血性脑卒中事件发生至关重要因素。
Objective To evaluate the mode of carotid artery remodeling with mild to moderate stenosis by high resolution magnetic resonance imaging and to explore the relationship between the vascular remodeling pattern and the occurrence and development of carotid artery plaque in ischemic stroke. Methods Thirty-two patients with carotid atherosclerosis and acute ischemic stroke or transient ischemic attack ≥2 mm in plaque were enrolled in this study. High-resolution MRA was performed. According to the signals of plaque and the integrity of the surface fiber cap, the stability of the plaque was determined. At the same time, the total lumen and tube wall area of the thickest level of the plaque, distal and proximal reference points were measured, Remodeling index (RI), plaque burden and plaque size. RI≥1.05 was positive remodeling (PR), RI <1.05 was non-positive remodeling (nonPR). The difference of measurement indexes between PR group and Non-PR group was compared, and the correlation between reconstruction model and plaque vulnerability was analyzed. Results A total of 55 carotid plaques were detected. There was no significant difference in total luminal area, wall area and normalized index between PR group and Non-PR group (P> 0.05). The plaque burden and plaque The difference in block size was statistically significant (P <0.001). There was no significant difference in the correlation between reconstruction pattern and plaque fragility (χ ~ 2 = 0.532, P> 0.05). CONCLUSIONS: PR predominates in mild to moderate vascular stenosis at early stage. There is no positive correlation between remodeling pattern and the vulnerability of plaque. Changes in plaque itself are the most important factors that lead to ischemic stroke.